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Physicians: Are you ordering DMEPOS for your 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 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practitioner documents and communicates that the face-to-face occurred within six months prior to the WOPD (unless superseded by the local coverage determination (LCD) and related policy article) to the supplier.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 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

References