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,
IBC may seek repayment from the DME supplier for claims not properly documented.
Prescription (order) requirements
Before submitting a claim to IBC, 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 IBC 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.