Proof of Delivery - JA DME
Proof of Delivery
42 CFR 424.57(c)(12) requires suppliers to maintain proof of delivery (POD) documentation in their files.
POD documentation, as well as claims documentation, must be maintained in the supplier's files for 7 years (starting from the DOS).
Suppliers, their employees, or anyone else having a financial interest in the delivery of the item(s) are prohibited from signing and accepting an item on behalf of a beneficiary (i.e., acting as a designee on behalf of the beneficiary). The relationship of the designee to the beneficiary should be noted on the delivery slip obtained by the supplier (i.e., spouse, neighbor). The signature of the designee should be legible. If the signature of the designee is not legible, the supplier/shipping service should note the name of the designee on the delivery slip.
For the purpose of the delivery methods noted below, designee is defined as any person who can sign and accept the delivery of DMEPOS on behalf of the beneficiary.
The supplier should also have on file any documentation containing a description of the item delivered to the beneficiary to determine the accuracy of claims coding including, but not limited to, a voucher, invoice or statement in the supplier records. A description of the items(s) delivered must be noted on the POD. The description can be either a narrative description (e.g., lightweight wheelchair base), a HCPCS code, the long description of a HCPCS code, or a brand name/model number.
POD documentation must be available to the Medicare contractor on request. All services that do not have appropriate POD from the supplier will be denied and overpayments will be requested. Suppliers who consistently fail to provide documentation to support their services may be referred to the Office of Inspector General (OIG) or the National Provider Enrollment for investigation and/or imposition of sanctions.
As a general Medicare rule, the date of service shall be the date of delivery. There are three methods of delivery. Regardless of the method of delivery, the contractor must be able to determine that the item(s) delivered are the same item(s) submitted for Medicare reimbursement and that the item(s) were received by a specific beneficiary:
- Delivery directly to the beneficiary or authorized representative
- Delivery via shipping or delivery service
- Delivery of items to a nursing facility on behalf of the beneficiary
Method 1 - Direct Delivery to the Beneficiary 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 document. The POD document must include:
- Beneficiary's name
- Delivery address
- A description of the item(s) being delivered. The description can be either a narrative description (e.g., lightweight wheelchair base), a HCPCS code, the long description of a HCPCS code, or a brand name/model number
- Quantity delivered
- Date delivered
- Beneficiary (or designee) signature
The date delivered on the POD must be the date that the DMEPOS item was received by the beneficiary or designee. The date of delivery may be entered by the beneficiary, designee, or the supplier. When the supplier's delivery documents have both a supplier-entered date and a beneficiary or beneficiary's designee signature date on the POD document, the beneficiary (or designee) entered date is the proof of delivery (DOS).
In instances where the supplies are delivered directly by the supplier, the date the beneficiary received the DMEPOS supply must be the DOS on the claim.
Method 2 - Delivery via Shipping or Delivery Service Directly to a Beneficiary
If the supplier uses a shipping service or mail order, the POD documentation must be a complete record tracking the item(s) from the DMEPOS supplier to the beneficiary. An example of acceptable POD would include both the supplier's own detailed shipping invoice and the delivery service's tracking information. The supplier's record must be linked to the delivery service record by some clear method like the delivery service's package identification number or supplier's invoice number for the package sent to the beneficiary. The POD document must include:
- Beneficiary's name
- Delivery address
- Delivery service's package identification number, supplier invoice number, or alternative method that links supplier's delivery documents with delivery service's records
- A description of item(s) being delivered. Description can be a narrative description (e.g., lightweight wheelchair base), a HCPCS code, the long description of a HCPCS code, or a brand name/model number
- Quantity delivered
- Date delivered
- Evidence of delivery
If a supplier utilizes a shipping service or mail order, suppliers have two options for the DOS to use on the claim.
- Suppliers may use shipping date as DOS. Shipping date is defined as date delivery/shipping service label is created or date item is retrieved by shipping service for delivery; however, such dates should not demonstrate significant variation
- Suppliers may use date of delivery as DOS on claim
Suppliers may also use a return postage-paid delivery invoice from the beneficiary or designee as a POD. This type of POD document must contain the information specified above.
Method 3 - Delivery to Nursing Facility on Behalf of a Beneficiary
For items directly delivered by the supplier to a nursing facility or when a delivery service or mail order is used to deliver the item(s) to a nursing facility, the supplier must have:
- Documentation demonstrating delivery of item(s) to facility by supplier or delivery entity; and,
- Documentation from nursing facility demonstrating receipt and/or beneficiary usage of item(s). Quantities delivered and used by the beneficiary must justify quantity billed
Equipment Retained from a Prior Payer
When a beneficiary receiving a DMEPOS item from another payer (including a Medicare Advantage plan) becomes eligible for the Medicare Fee For Service (FFS) program, the first Medicare claim for that item or service is considered a new initial Medicare claim. Medicare does not automatically continue coverage for any item obtained from another payer when a beneficiary transitions to Medicare coverage.
For Medicare to provide payment, the beneficiary must meet all Medicare coverage, coding, and documentation requirements for the DMEPOS items in effect on the DOS of the initial Medicare claim.
A POD is required for all items, even those in the beneficiary's possession provided by another insurer prior to Medicare eligibility.
Proof of Delivery Requirements of Delivery Requirements for Recently Eligible Medicare FFS
The supplier record must document:
- Statement, signed and dated by beneficiary (or beneficiary's designee), that supplier has examined item, meets POD requirements; and
- Supplier attestation that item meets Medicare requirements
For the purposes of reasonable useful lifetime and calculation of continuous use, the first day of the first rental month in which Medicare payments are made for the item (i.e., DOS) serves as the start date of the reasonable useful lifetime and period of continuous use. In these cases, the POD documentation serves as evidence that the beneficiary is already in possession of the item.
Exceptions
Discharge from Hospital or Nursing Facility
Exceptions to the preceding statements concerning the date(s) of service on the claim occur when the items are provided in anticipation of discharge from a hospital or nursing facility. A supplier may deliver a DMEPOS item to a patient in a hospital or nursing facility for the purpose of fitting or training the patient in the proper use of the item. This may be done up to two days prior to the patient's anticipated discharge to their home. Further, a supplier may deliver a DMEPOS item to a patient's home in anticipation of discharge from a hospital or nursing facility. In each case, the supplier shall bill the date of service on the claim as the date of discharge and use the Place of Service (POS) as 12 (Patient's Home). The item must be for subsequent use in the patient's home. No billing may be made for the item on those days the patient was receiving training or fitting in the hospital or nursing facility.
A supplier may not bill for drugs or other DMEPOS items used by the patient prior to the patient's discharge from the hospital or a Medicare Part A nursing facility stay. Billing the DME MAC for surgical dressings, urological supplies, or ostomy supplies that are provided in the hospital or during a Medicare Part A nursing facility stay is not allowed. These items are payable to the facility under Part A of Medicare. This prohibition applies even if the item is worn home by the patient from the hospital or nursing facility. Any attempt by the supplier and/or facility to substitute an item that is payable to the supplier for an item that, under statute, should be provided by the facility, may be considered to be fraudulent. These statements apply to DME delivered to a patient in hospitals, skilled nursing facilities (POS = 31), or nursing facilities providing skilled services (POS = 32).
Payment for Delivery and Service Charges for Durable Medical Equipment
Delivery and service are an integral part of oxygen and durable medical equipment (DME) suppliers' costs of doing business. Such costs are ordinarily assumed to have been considered by suppliers (along with all other overhead expenses) in setting the prices they charge for covered items and services. As such, these costs have already been accounted for in the calculation of the fee schedules. Also, most beneficiaries reside in the normal area of business activity of one or more DME supplier(s) and have reasonable access to them.
Therefore, DME MACs may not allow separate delivery and service charges for oxygen or DME except as specifically indicated in CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 20, Section 90 or in rare and unusual circumstances when the delivery is not typical of the supplier’s operation.
There may be situations where beneficiaries live in remote areas that are not served by a local supplier or when a local supplier(s) is temporarily out of stock of required oxygen or equipment and the DME dealer incurs extraordinary delivery expenses. For example, DME MACs may recognize a reasonable separate delivery charge when the supplier must deliver an item of DME outside its normal area of business activity and the beneficiary does not have access to a supplier whose location is nearer.
When a supplier delivers oxygen or DME outside the area in which he/she normally does business, but the item could have been obtained locally, DME MACs may allow any separate additional delivery charge only to the extent that it does not raise the total payment for the oxygen or DME above the local fee schedule.
Suppliers should work with the beneficiary to find a local supplier to help with their DMEPOS needs. See CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 20, Section 60
