| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| December 04, 2008 FAQ: Order (Prescription) RequirementsQ. May a supplier furnish a DMEPOS item based on a verbal or preliminary written order?A. Yes, unless the LCD states otherwise. Most DMEPOS items can be dispensed based on a verbal or preliminary order, provided that a supplier has a detailed written order in its files prior to submitting a claim for the item. The dispensing order must include the beneficiary's name, a description of the item, the physician's name and the start date of the order. If the elements of the preliminary order are documented in different parts of the beneficiary's medical record, e.g. discharge summary and the hospital medical record, the supplier must nonetheless be able to show documentation for each of the requirements for preliminary orders. Q. May a supplier submit a claim for reimbursement of a DMEPOS item prior to obtaining a detailed written order from the treating physician?A. No. If a supplier does not have a faxed, photocopied, electronic or pen and ink signed detailed written order in its records before submitting a claim, the claim will be denied. A detailed written order must be sufficiently detailed, including all options or additional features that will be separately billed or that will require an upgrade code. If the order is for supplies that will be used on a periodic basis, the detailed written order should include information on the quantity used, frequency of change, and duration of need. The detailed description of the item can either be a narrative description or a brand and model number. Someone other than the physician may complete the detailed description of the item. However, the treating physician must review the detailed description and personally sign and date the order. For example, a detailed written order for a manual wheelchair must specify the start date of the order, the beneficiary's name and must be sufficiently detailed, so as to include all options or additional features that will be separately billed or that will require an upgraded code. The description can be either a narrative description (e.g., lightweight wheelchair base) or a brand name/model number. A claim may be submitted to secure a denial for COB purposes when billing for DMEPOS items dispensed without a written order. The item must be billed with the EY modifier. If the supplier has obtained a written order for some, but not all, of the items provided to a particular beneficiary, the supplier must submit a separate claim for the items dispensed without a written order. Q. Are there any DMEPOS items that require a supplier to obtain a detailed written order prior to delivery (WOPD)?A. Yes. A detailed WOPD is required for:group 1,2 and 3 pressure reducing support surfacesseat lift mechanismsTENS unitspower operated vehiclespower wheelchairsnegative pressure wound therapywheelchair seatingwheelchair options and accessories provided for power wheelchairsThe DME MACs may identify other items for which they will require a detailed WOPD. For these items, the supplier must have received a detailed written order that has been both signed and dated by the treating physician and that complies in all respects with the requirements applicable to detailed written orders before dispensing the item. Refer to the applicable LCD for the specific HCPCS codes that are included in this requirement. If a supplier bills for an item that requires a detailed WOPD prior to obtaining the written order, the item will be denied as excluded by statute; even if the supplier subsequently obtains a detailed WOPD. Q. Is a supplier required to obtain a detailed WOPD in order to receive Medicare payment for a manual or semi electric hospital bed?A. No. The requirement for a detailed WOPD applies to support surfaces and beds identified in the LCDs for Group I, Group II and Group III support surfaces. Q. May a supplier furnish an item requiring a detailed WOPD such as a pressure reducing mattress overlay, a power wheelchair or a TENS unit to a Medicare beneficiary on the basis of a detailed WOPD that has been electronically signed and date stamped?A. Yes. A valid detailed WOPD must meet all the requirements applicable to detailed written orders. This means that the detailed WOPD must clearly specify the start date of the order, identify the beneficiary, and include a description of the item that is sufficiently detailed, including all options or additional features that will be separately billed or that will require an upgrade code. A detailed WOPD that has a secure, authenticated electronic signature and date stamp and that meets all of the requirements applicable to detailed written orders, is valid for furnishing and billing of these items. |
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