National Government Services (NGS), the Jurisdiction B DME MAC, has created several letters to educate physicians on their roles in providing documentation to DME suppliers.
The letters are signed by Jurisdiction B DME MAC Medical Director Dr. Adrian Oleck.
The most general of the letters explains the role of the physician in the DME process — namely to adequately document patients’ conditions in their medical records so appropriate DME can be purchased by Medicare. That letter spells out the physician’s legal obligations and adds that the physician cannot charge a fee to the beneficiary or supplier requesting the information.
A much more detailed letter is also available to explain the documentation process for funding power wheelchairs and scooters (POVs). Among the topics covered in that letter:
• The face-to-face examination requirement.
• The use of supplier-generated forms as documentation.
• The level and detail of patient medical history required, including symptoms, diagnoses, pace of ambulation, what ambulatory assistance is already being used, how far the patient can walk without stopping, and the patient’s ability to stand from a seated position without assistance.
• The need for a physical examination “relevant to mobility needs” of the patient.
• Medicare’s policy of funding only mobility equipment that will be used “in the home.”
• Collaborating with a physical or an occupational therapist to complete the patient’s mobility evaluation.
• The seven elements that the mobility prescription must contain.
• Medicare reimbursement to the physician for time spent on patient documentation.
• The 45-day window for physicians to forward the prescription and face-to-face record to the supplier following the exam.
The letter encourages physicians to address each patient’s unique conditions and needs and to “paint a picture of your patient’s functional abilities and limitations on a typical day.”
A similar physician letter is also available on the topic of CPAPs.
The letters are available as online downloads by going to www.ngsmedicare.com. Enter “physician documentation letter” in the Search field on the NGS home page, then click on the letter you want to download.
