WHAT YOU NEED TO KNOW
For a patient with a documented medical need for medical equipment, Medicare general will cover the items needed. However, they have very specific requirements that need to be addressed in a medical record.
FACE TO FACE EXAMINATION
Medicare requires the patient to have seen a physician, physician’s assistant, registered nurse practitioner, or a clinical nurse specialist who addressed the condition that is causing the needs for the medical device, within six months prior to the ordered.
The order must be signed by the physician, with the supervising physician signing off on an exam conducted by a P.A., Rn.P., or C.N.S..
Tip: Generally, a patient has been seen by a doctor within 6 months when medical equipment is needed. We can often use this exam to fill the Face to Face requirement.
PROGRESS NOTES & ADDENDUMS
If the Face to Face examination does not discuss the items required for coverage, the missing information may be addressed through a progress note or addendum.
A Progress Note is often prepared by a nurse or other clinician from the patient’s care team and becomes part of the medical record. Therefore, a progress note is accepted by Medicare. Sometimes, the clinician may see document-able circumstances in the home environment that can address the coverage requirements.
A physician will document whatever he or she sees necessary while conducting an exam for a patient, but the requirements for coverage of the item being ordered may not be completely addressed.
The only way for a physician to add to his or her exam report in these cases is by using an addendum. This addendum adds additional information and observations to the report that were not specifically noted by the physician. They can also be used to clarify vague doctor’s notes when needed.
DETAILED WRITTEN ORDERS
Medicare requires all prescriptions for medical equipment to contain several specific items that are not present on most common prescriptions. The DWO must also be signed and dated prior to delivery of the item.
Patient’s HIC Number
Item Description (with HCPCS code)
Description of any Accessories Included in the Order (with HCPCS code)
Directions for Use (when appropriate)
Prescriber’s NPI Number (individual, not group)
CERTIFICATES OF MEDICAL NECESSITY, TESTING AND OTHER ITEMS
Some medical items require further documentation, like testing or a certificate of medical necessity (CNM).
A Certificate of Medical Necessity is required for oxygen equipment. An oxygen order that is missing the CMN will cause us to prepare the document and return it to your office for completion and signature.
Oxygen therapy requires testing in addition to the examination requirements, either pulse oximetry, or an arterial blood gas (ABG).
A failed swallow test must be included in all prescriptions for enteral nutrition.