top of page
  • Angel Callaway, CPC, CPB

Are you billing DMEPOS items?

If you are billing CMS for any Durable Medical Equipment, Prosthetics, Orthotics and Supplies, your documentation must meet Medicare guidelines for CMS to issue payment.


CMS requires documentation to include:


  • Diagnosis

  • Type and quantities of items ordered

  • Frequency of use (or replacement, if applicable)

  • Duration of the condition

  • Clinical course (improving or worsening)

  • Prognosis

  • Nature and extent of functional limitations

  • Other therapeutic interventions and results

  • Experience with related items

The patient medical records may include records from other facilities e.g. hospitals, nursing homes, home health, and other providers to meet medical necessity.


Some DMEPOS items may require a Certificate of Medical Necessity (CMN) or DME Information Form (DIF). It is recommended that a copy be retained in the patient medical record. This form alone is not enough to provide medical necessity.


The documentation does not routinely need to be submitted to DME MAC, however the DME MAC may request this information in selected cases. If the documentation does not support medical necessity when reviewed the provider/supplier of the DME is liable for the cost of the DME, unless a properly executed ABN has been obtained prior to the services rendered.


You can find CMS complete DMEPOS billing guidelines and which items require a CMN/DIF here: Medicare Program Integrity Manual, Chapter 5 (PDF)

10 views0 comments

Recent Posts

See All

Congratulation to Our Staff

Apex Practice Solutions has received an A+ rating from the BBB for another year. We could not have achieved this top rating without our amazing staff. Thank you to our staff for doing such a great job

Self-Pay Billing

Billing for self-pay is pretty straightforward, however, there are some considerations to keep in mind. 1. Medicare law prohibits submitted claims to Medicare that contains charges substantially in ex

Let Us Simplify the Credentialing Process

Are you tired of shuffling papers and spending hours on applications just to have them rejected or returned for missing information? Are you losing money while waiting for your credentialing applicat

Comments


bottom of page