DME Documentation Requirements

by  Wyn Staheli, Director of Content - innoviHealth
Dec 28th, 2017

Properly documenting DME orders is crucial for reimbursement. It should be noted that without meeting the payer requirements, the claim will be denied. For Medicare, the beneficiary will not be responsible for paying for the item if the provider and/or supplier do not meet requirements. Commercial payers have similar policies so carefully review payer policies to ensure that all DME requirements are met.

The information in this tip comes from LCDs.

Resource: See Resource 518 to review the Medicare Manual, Chapter 5 – Items and Services Having Special DME Review Considerations.

PRESCRIPTION (ORDER) REQUIREMENTS

Dispensing Order Requirements

Dispensing order must contain all of the following:

• Description of the item
  
  
• Beneficiary’s name
  
  
• Prescribing physician’s name
  
  
• Date of the order and the start date, if the start date is different from the date of the order. For verbal orders, use the date the supplier is contacted by the physician. For written dispensing orders, use the date entered by the physician.
  
  
• Signature that complies with Medicare signature standards. A physician signature (if it’s a written order) or supplier signature (if it’s a verbal order).
  
  
• Detailed written order (see the following section for requirements)

Note: A dispensing order is only required if the item(s) is dispensed prior to obtaining the detailed written order. Suppliers should not submit claims prior to obtaining a valid detailed written order. Supplies billed before a signed and dated order has been received must be submitted with modifier GY and will be denied as noncovered.

Detailed Written Order (DWO) Requirements

Detailed written order must contain all of the following and be available upon request:

• Beneficiary’s name
  
  
• Physician’s name
  
  
• Date of the order and the start date. If the start date is different from the date of the order, use the date the supplier is contacted by the physician (for verbal orders) or the date entered by the physician (for written dispensing orders)
  
  
• Detailed description of the item(s) including each separately billed component - this can be narrative description or brand name/model number
  
  
• Treating physician signature
  
  
• Date the treating physician signed the order
  
  
• Frequency of use information on orders must contain detailed instructions for use and specific amounts to be dispensed. Reimbursement shall be based on the specific utilization amount only. Orders that only state “PRN” or “as needed” utilization estimates for replacement frequency, use, or consumption are not acceptable.

Note: If the prescribing physician is also the supplier, a separate order is not required, but the item provided must be clearly noted in the patient’s record.

Other Required Information

1. Beneficiary authorization
   
   
2. Face-to-face office visit within six months prior to the order by the certifying healthcare provider. For Medicare, the provider must be one of the following: Physician, Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS). This visit can be conducted via telehealth where appropriate.

Note: For Medicare, certain items may require either a Certificate of Medical Necessity (CMN) or a DME Information Form (DIF). Be aware of which form(s) would be used in your practice.

Proof of Delivery (POD)

Suppliers are required to maintain POD documentation in their files. There are three Medicare approved methods of delivery:

1. Direct Delivery to the Benificiary by the Supplier: Suppliers may deliver directly to the beneficiary or the designee. In this case, POD to a beneficiary must be a signed and dated delivery slip. The POD record must include:
   
   
   • Beneficiary’s name
     
     
   • Delivery address
     
     
   • Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
     
     
   • Quantity delivered
     
     
   • Date delivered
     
     
   • Beneficiary (or designee) signature and date of signature

   NOTE: The signature date on the delivery slip must be the date the item was received by the beneficiary.

2. Delivery via Shipping or Delivery Service Directly to a Beneficiary: If the supplier utilizes a shipping service or mail order, the POD documentation must be a complete record tracking the item(s) fromtheDMEPOS supplier to the beneficiary. The POD record must include:
   
   
   • Beneficiary’s name
     
     
   • Delivery address
     
     
   • Delivery service’s package identification number, supplier invoice number, or alternative method that links the supplier’s delivery documents with the delivery service’s records
     
     
   • Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
     
     
   • Quantity delivered
     
     
   • Date delivered
     
     
   • Evidence of delivery

   NOTE: If a supplier utilizes a shipping service or mail order, suppliers must use the shipping date as the date of service on the claim.

3. Delivery to Nursing Facility on Behalf of a Beneficiary
   
   
   • When a supplier delivers items directly to a nursing facility, the documentation described for Method 1 (see above) is required.
     
     
   • When a delivery service or mail order is used to deliver the item to a nursing facility, the documentation described for Method 2 (see above) is required.