How to order DMEPOS items correctly?

According to the Medicare Program Integrity Manual, Chapter 5 (Things and Administrations Having Special DME Survey Considerations), before you dispense any DMEPOS thing to a beneficiary, you need to have an order from the treating physician. Please note that this article is planned for providers billing Durable Medical Equipment (DME) MACs for Durable Medical Equipment Prosthetics, Orthotics Supplies (DMEPOS) provided to Medicare beneficiaries. 

Verbal or preliminary composed orders: Providers may dispense most things of DMEPOS based on a verbal order or a preliminary composed order from the treating physician/practitioner. 

Detailed composed orders needed before claim submission: A detailed composed order may be a photocopy, facsimile image, electronic, or pen-and-ink original document. For all things, the provider shall have a detailed composed order prior to submitting a claim. 

• It needs to have a description of the thing to incorporate all alternatives or additional features that will be separately billed, or that will require an upgraded code. The description can be either a general description (for example, "wheelchair or hospital bed"), a brand name/model number, and HCPCS code or HCPCS code narrative. 
• It should incorporate the beneficiary name, the date of the order, and the physician/practitioner signature. 
• On the off chance that it is for a medication provided under the DME benefit, it should also determine the name of the medication, dosage, or concentration (if applicable), recurrence of administration (if applicable), duration of a mixture (if applicable), quantity to be dispensed, and the number of tops off. 

A nurse practitioner or clinical nurse specialist may provide the dispensing order and sign the detailed composed order when: 

• They meet the meaning of a nurse practitioner or clinical nurse specialist found in §1861(aa)(5)(A) and §1861(aa)(5)(B), separately. 
• They are treating the beneficiary for the condition for which the thing is required 
• They are practicing independently of a physician 
• They bill Medicare for other covered administrations utilizing their own provider number 
• They are allowed to do all of the above in the State where the administrations are delivered. 

Similarly, physician assistants may give the dispensing order and compose and sign the detailed composed order when: 

• They meet the meaning of physician assistant found in §1861(aa)(5)(A) of the Social Security Act 
• They are treating the beneficiary for the condition for which the thing is required 
• They are practicing under the supervision of a Doctor of Medicine or Doctor of Osteopathy 
• They have their own National Provider Identifier (NPI) 
• They are allowed to perform administrations as per State law. 

Things Requiring an Order Before Conveyance 

While many things of DMEPOS can be dispensed based on a verbal order or preliminary composed order from the treating physician/practitioner, there are certain things that statutorily require a composed order prior to dispensing/conveyance and are subject to face-to-face necessities. 

Things recognized by the Secretary as "Determined Covered Things" (meeting one of the three after criteria): 

• Anything described by a Healthcare Common Procedure Coding System (HCPCS) codes for the accompanying sorts of durable medical equipment: 

1. Transcutaneous electrical nerve stimulation (TENS) unit 
2. Roll about chair 
3. Oxygen and respiratory equipment 
4. Hospital beds and accessories 
5. Cervical traction 

• Anything of durable medical equipment that appears on the DMEPOS Expense Timetable with a value roof at or greater than $1,000 
• Any other thing of durable medical equipment that CMS adds to the rundown of Determined Covered Things through the notification and remark rulemaking measure. 

For such indicated things, Medicare would expect: 

• A composed order prior to dispensing/conveyance involved: 

1. The beneficiary name, 
2. A thing of DME ordered, 
3. Signature of prescribing practitioner, 
4. The prescribing practitioner NPI, and 
5. Date of the order. 

• A face-to-face experience having happened during the half-year prior to the composed order. 

Power mobility devices including: 

• Power wheelchairs (characterized as a four-wheeled motorized vehicle whose guiding is operated by an electronic gadget or a joystick to control bearing and turning) or 
• Power-operated vehicles (characterized as three or four-wheeled motorized bike that is operated by a turner) that a beneficiary uses in the home. 

For such power mobility devices, Medicare would expect: 

A composed order prior to dispensing/conveyance involved 

1. The beneficiary name, 
2. The date of the face-to-face examination, 
3. The diagnoses and conditions that the PMD is expected to adjust, 
4. A description of the thing (for example, a narrative description of the particular kind of PMD), 
5. The length of need, 
6. The physician or treating practitioner's signature, and 
7. The date the solution was composed. 
8. The composed order should be marked and dated by the physician or treating practitioner who performed a face-to-face examination. The order and report of the face-to-face examination should be gotten by the provider within 45 days of the date of examination. The face-to-face examination prerequisite doesn't apply when just accessories for power mobility devices are being ordered. 

Remember that on the off chance that you don't have an order meeting the prerequisites and timeframes determined above, your MAC will consider the thing non-covered, and your claim will be denied.