TriCenturion Medical Director's Letter Explains Documentation Requirements

Dr. Paul J. Hughes, medical director of TriCenturion, has penned a letter to physicians to explain their responsibilities regarding documentation for all DME purchased by Medicare.TriCenturion is the Centers for Medicare & Medicaid Services (CMS) Program Safeguard Contractor (PSC) for Jurisdictions A and B.

In the letter, Hughes explains that physicians bear responsibility “to determine and document the medical need for all health-care services. For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient documentation of the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable).”

Hughes adds that documentation should include the patient’s diagnosis and other critical information such as duration of condition, prognosis, how function is being negatively affected and other therapeutic interventions that have been tried.“DMEPOS suppliers are your partners in caring for your patient,” Hughes says in the letter.“They will not receive payment from Medicare for the items that are ordered if you do not provide information from your medical records when it is requested. Furthermore, not providing this information may result in your patients having to pay for the item themselves.”

The letter states that the Social Security Act requires physicians to provide the information”at the time that the item or service is ordered by the physician or practitioner.” Hughes adds that physicians are obliged to provide the information without charging the DME supplier or the beneficiary.

To read the entire letter (or to make copies for your referral sources’ education), go to TriCenturion’s Web site:

This article originally appeared in the January 2008 issue of Mobility Management.

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