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Expedite Review with Labeled Documentation

Providers and Suppliers are encouraged to label/tab submitted documentation. This voluntary effort will help providers/suppliers validate that all requested records are submitted and to ensure reviewers can easily identify such elements within the medical record.

Documentation

Suppliers are reminded to review the Local Coverage Determination (LCD) and Policy Article for specific documentation guidelines.

Beneficiary Authorization - A request for payment signed by the beneficiary must be filed on or with each claim for charge basis reimbursement except in certain situations.

Certificates of Medical Necessity (CMNs) or DME Information Forms (DIFs) - A Certificate of Medical Necessity (CMN) or a DME Information Form (DIF) is a form required to help document the medical necessity and other coverage criteria for selected DMEPOS items. For certain items or services billed to a DME MAC, the supplier must receive a signed CMN from the treating physician or a signed DIF from the supplier.

Continued Use / Continued Need - Continued use describes the ongoing utilization of supplies or a rental item by a beneficiary. There must be information in the beneficiary's medical record to support that the item continues to be used by the beneficiary and remains reasonable and necessary.

Detailed Written Orders - If a supplier does not have a faxed, photocopied, electronic or pen and ink signed order in their records before they submit a claim to Medicare (i.e., if there is no order or only a verbal order), the claim will be denied.

Dispensing Orders - A dispensing order may be verbal or written. The supplier must keep a record of the dispensing order on file.

Medical Records - The medical record is not limited to physician's office records but may include records from hospitals, nursing facilities, home health agencies, other healthcare professionals, etc. (not all-inclusive).

Orders - A supplier must have an order from the treating physician before dispensing any DMEPOS item to a beneficiary.

Pick Up Slips - A pick-up slip is written confirmation, provided by a supplier, that the supplier has removed an item of DME from the beneficiary's home.

Proof of Delivery - Proof of delivery ensures a supplier properly coded the item(s), that the item(s) delivered are the same item(s) submitted for Medicare reimbursement and that the item(s) are intended for, and received by, a specific Medicare beneficiary.

Refill Documentation - Information regarding routine refills, itemized sales slips, documentation prior to delivery and other elements of refill records is provided.

Requirement of New Orders - A new order is required when there is a change in the order for the item, if it is specified in the documentation section of a particular medical policy, when an item is replaced, and when there is a change of supplier.

Signature Requirements - For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author. The method used shall be a hand written or an electronic signature. Stamp signatures are not acceptable.

Supplier Documentation - Suppliers are required to have documentation on file prior to submitting their claim to Medicare.

 

Last Updated Jun 28, 2017

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