Physicians Ordering DMEPOS for Patients

Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or supplies billed to the Medicare program.

Medical Records

Medical records should be complete, legible, and include the following information:

  • Reason for encounter, relevant history, physical exam findings, test results and date of service
  • Assessment and impression of diagnosis
  • Plan of care with date and legible signature
  • Documentation that supports that the rendering/billing provider indicated on claim is the healthcare professional providing the service
  • Records should not only substantiate service performed but also required level of care

Documentation Requirements

  • Standard Written Order (SWO) prescription (not considered part of medical record)
    • Exception to SWO - prescribing practitioners who are also suppliers
      • SWO elements may be listed in medical record
  • Written Order Prior to Delivery (WOPD) for items on the CMS required list (can serve as SWO)
    • Face-to-Face (F2F) encounter

For DMEPOS items on the required F2F and WOPD list, the treating practitioner documents and communicates that the F2F occurred within six months prior to the WOPD (unless superseded by the Local Coverage Determination (LCD) and related policy article) to the supplier.

Who Can Complete a SWO?

Power Mobility Devices (PMDs)

  • Treating practitioner who conducts qualifying face-to-face (F2F) prepares SWO for PMD base

All DMEPOS items except PMDs

  • Certain elements of order may be completed by someone other than the treating practitioner
    • Treating practitioner identified in order must sign the document

Resources

 

Last Updated Mar 24 , 2022