Article Detail - JA DME

In order to justify payment for DMEPOS items, suppliers must meet the following requirements:

• Standard Written Order (SWO)
• Medical Record Information (including continued need/use if applicable)
• Correct Coding
• Proof of Delivery

No more than one month's supply of parenteral nutrients, equipment or supplies is allowed for one month's prospective billing. Claims submitted retroactively, may include multiple months.

The treating practitioner expectations:

• Evaluate the beneficiary within 30 days prior to initial certification/required recertification (but not revised certifications)
• If treating practitioner does not see beneficiary within this timeframe, he/she must;
  • Document reason why beneficiary was not seen; and
  • Describe what other monitoring methods were used to evaluate beneficiary's parenteral nutrition need

The medical records must include enough information to support that coverage criteria have been met, including, but not limited to:

• Beneficiary’s diagnosis
• Duration of beneficiary’s condition
• Clinical course (worsening or improvement)
• Prognosis
• Nature and extent of functional limitations
• Other therapeutic interventions and results
• Previous experience with related items
• Any other pertinent information related to use of parenteral nutrition

Refer to the Noridian Medicare Parenteral Nutrition webpage for additional resources.