Accurate billing is critical for DME and HME providers to maintain profitability and ensure patients receive the equipment they need for ongoing care. Medicare DME documentation requirements can be very specific, and failure to meet those requirements can result in denied claims, delayed payments, and even legal ramifications.
The list of requirements is more extensive and complex than we can cover in a single blog post, but we can at least show you where to start. In this article, we’ll go over some of the typical things you should expect in Medicare DME documentation requirements, as well as some ways Medbill can help ensure compliance and dependable reimbursement.
Standard Written Order (SWO)
One requirement you can depend on seeing for your Medicare DME documentation requirements is an SWO, or Standard Written Order. This is essentially a detailed prescription that will be required for any and all DME claims submitted to Medicare.
For the sake of appropriate documentation (and avoiding denied claims) any SWO submitted to Medicare will need to include the following elements:
- The patient’s name or MBI (Medicare Beneficiary Identifier)
- The date the DME was ordered
- A general description of the ordered item (though the specifications may vary based on the DME in question)
- Specified quantity of equipment
- Practitioner identification, including the treating practitioner’s name or NPI (National Practitioner Identifier), and a valid signature
Sometimes even standard requirements can get complicated — helping people stay healthy is no simple business. For any questions or concerns you may have regarding the information that is (or is not) present on your SWO, Medbill is here to help.
Documentation of Medical Necessity
To receive reimbursement for DME supplies, documentation proving medical necessity will always be required as well. This documentation should include the patient’s medical history, diagnosis, and the reason that the specific equipment is needed for their ongoing care. Bear in mind that all of this information is vital, and the omission of any elements may be grounds for claims denial.
Proof of Delivery (POD)
All DME items will require proof of delivery, also called POD. This will generally include the patient’s name, the delivery date of the DME, and the name and quantity of the items delivered. A signature from the person who received the equipment will also be required. Bear in mind, it’s essential that you verify that the signature is legible and that the delivery date falls within Medicare’s expected timeframe.
Supplier Standards Documentation
Medicare requires that DME suppliers meet certain criteria as well, such as maintaining a physical location, adhering to quality control standards, and holding the necessary licenses and certifications. To avoid denied claims and legal ramifications, it is critical to keep documentation that proves compliance with these standards, including up-to-date licensure.
Finally, it is essential to verify and re-verify that all Medicare reimbursement claims contain the necessary documentation. This includes ensuring that the claim contains all required information, such as the Medicare number of the patient, the date of service, and the specific equipment provided. When it comes to Medicare DME documentation requirements, accuracy is of the utmost importance.
Medicare DME Documentation Requirements and You
While Medicare DME documentation requirements can be complex and time-consuming, failure to meet them can result in serious consequences. Medbill can help DME and HME suppliers like you comply with Medicare regulations by providing comprehensive and accurate documentation with every claim.
Though Medicare DME documentation requirements can be complicated and tedious, it’s nothing your company can’t handle with the right team on your side.
Contact Medbill today to simplify your Medicare DME billing procedures.
For more information regarding Medicare DME documentation requirements, visit CMS.GOV.