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| Obtaining Medical Necessity Documentation from Physicians National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has received several inquiries in regards to suppliers having difficulty obtaining medical necessity documentation from the treating physician. Some suppliers are unable to receive the documentation due to the physician's refusal to release the medical records. To assist suppliers in obtaining medical necessity documentation from the physicians, the Medicare contractors have developed letters to aid in obtaining these records. These letters should be used when trying to obtain medical records from the physicians. The letters provide an explanation of the physician's obligation by law to provide the requested medical records to the supplier. Suppliers are encouraged to utilize the following letters: Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) - Physician Documentation Letter http://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/MD%20Documentation.pdf. Power Mobility Devices - Physician Documentation Letterhttp://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/PMDDocument_DearPhysician.pdf . Positive Airway Pressure Device - Physician Documentation Letterhttp://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/Positive%20Airway%20Pressure_PAP_Devices_for_Obstructive_Sleep_Apnea_Letter.pdf . Suppliers are also encouraged to get the beneficiary involved. The beneficiary can contact their physician to request the medical records that are needed. If all avenues have been exhausted and the physician is not cooperating, suppliers do have the option to report the physician to the Program Safeguard Contractor (PSC). The report should be made in the state in which the physician practices in. For the states of Ohio and Kentucky, AdvanceMed is the PSC. Reports can be filed at: http://www.csc.com/advancemed/contact_us For the states of Illinois, Indiana, Wisconsin, Minnesota, and Michigan, Trust Solutions is the PSC. Reports for TrustSolutions can be filed via on-line, mail, or fax. By Mail: By FAX: (414) 459-2857TrustSolutions, LLC 6775 West Washington Street Milwaukee, WI 53214 Some policies require that suppliers have specific medical documentation on file prior to submitting a claim to the DME MAC. Please be sure to refer to each individual medical policy to verify the documentation requirements, modifier usage and coverage criteria. |
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