Many durable medical equipment (DME) suppliers and professional providers are aware of and currently comply with policy documentation requirements; however, we sometimes receive questions about what documentation is required and must be kept on file for orders of DME, prosthetics, orthotics, and supplies (e.g., ostomy supplies, splint supplies provided in the office setting, urinary drainage bag supplies, supplies for the treatment of diabetes). This article summarizes some of our long-standing documentation requirements. Our requirements are consistent with the Centers for Medicare & Medicaid Services documentation requirements, which underscore the importance of securing and retaining documentation. If required documentation is not available on file to support a claim at the time of an audit or record request, AmeriHealth may seek repayment from the DME supplier for claims not properly documented.

Prescription (order) requirements

Before submitting a claim to AmeriHealth, the supplier must have on file a timely, appropriate, and complete order for each billed item that is signed and dated by the member?s servicing provider. Note: This requirement cannot be satisfied by having a provider sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order.

Proof of delivery

Medical record documentation must include a contemporaneously prepared delivery confirmation or member's receipt of supplies and equipment. If delivered by a commercial carrier, the medical record documentation must include a copy of delivery confirmation. If delivered by the DME supplier/provider, the medical record documentation must include a copy of delivery confirmation that is signed by the member or caregiver. All documentation must be prepared at the same time as delivery and be available to AmeriHealth upon request.

Consumable supplies

The DME supplier must monitor the quantity of accessories and supplies that a member is actually using. To do so, the DME supplier should contact the member regarding replenishment of supplies no sooner than approximately seven days prior to the delivery/shipping date. Dated documentation of this member contact is required in his or her medical record. Delivery of the supplies should be done no sooner than approximately five days before the member would exhaust his or her on-hand supply. More information about our documentation requirements for DME services is available within the applicable medical policies on our Medical Policy Portal. Select Accept and Go to Medical Policy Online, then type a keyword or medical code in the Search box. If you have any questions, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator.