How to order DMEPOS items correctly?

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

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

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

• It needs to have a description of the item to incorporate all options 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 given under the DME advantage, it should also determine the name of the medication, dosage, or concentration (if applicable), recurrence of administration (if applicable), duration of infusion (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 written order when: 

• They meet the definition 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 item 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 written order when: 

• They meet the definition 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 item 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. 

Items Requiring an Order Before Delivery 

While many items of DMEPOS can be dispensed based on a verbal order or preliminary written order from the treating physician/practitioner, there are certain items that statutorily require a written order prior to dispensing/delivery and are dependent upon face-to-face prerequisites. 

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

• Any item portrayed by a Healthcare Common Procedure Coding System (HCPCS) codes for the accompanying kinds 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 

• Any item of durable medical equipment that appears on the DMEPOS Fee Schedule with a price ceiling at or greater than $1,000 
• Any other item of durable medical equipment that CMS adds to the list of Specified Covered Items through the notice and comment rulemaking process. 

For such specified items, Medicare would expect: 

• A written order prior to dispensing/delivery comprised of: 

1. The beneficiary name, 
2. An item 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 6 months prior to the written 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 direction 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 written order prior to dispensing/delivery comprised of 

1. The beneficiary name, 
2. The date of the face-to-face examination, 
3. The diagnoses and conditions that the PMD is expected to change, 
4. A description of the item (for example, a narrative description of the particular sort of PMD), 
5. The length of need, 
6. The physician or treating practitioner's signature, and 
7. The date the prescription was written. 
8. The written 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 only accessories for power mobility devices are being ordered. 

Recollect that in the event that you don't have an order meeting the prerequisites and timeframes specified above, your MAC will consider the item non-covered, and your claim will be denied.