Physicians! Are You Ordering DMEPOS for Your Patients?

Published 04/26/2022

Physicians provide the foundation for correctly billing services and/or supplies to Medicare. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (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 encounter
For DMEPOS items on the required face-to-face and WOPD list, the treating practitioner documents and communicates that the face-to-face occurred within six months prior to the WOPD (unless superseded by the Local Coverage Determination and related policy article) to the supplier.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

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