According to Medicare’s learning network, “The law requires that a physician must document that a physician, nurse practitioner (NP), physician assistant (PA) or clinical nurse specialist (CNS) has had a face-to-face encounter with the patient. The encounter must occur within the six months before the order is written for the DME or Durable Medical Equipment. A detailed written order shows the diagnosis as well as the codes that are needed for the insurance to verify that the physician signed off on. It is necessary to have the prescription signed within 6 months of the physician evaluating the patient so that the specific diagnosis is as up to date and as accurate as possible as well as ensuring the doctors ability to order it. The physician also needs to deem this medically necessary for the patient for the insurance to be able to approve the device.
While the patient is in the office the practitioner must assess the patient to determine the next steps for the patient regarding the need for DME. The Centers for Medicare and Medicaid Services (CMS) manuals state the following must be provided in order to obtain the proper information: the beneficiary’s name, item of DME ordered, prescribing practitioner’s National Provider Identifier (NPI), signature of the ordering practitioner and the date of the order. Neglecting to meet these requirements for the equipment can result in the denial of the claim. According to the CMS, if a DME item is ordered by a PA, NP, or CNS, a physician must document the initial encounter of the patient by signing and dating the pertinent portion of the medical record. It is very important that all the necessary documents are signed and dated properly to ensure the ability to obtain the DME. The prescription is required stating the physician stated it is medically necessary and needs to be within six months to clarify accuracy as well as being medically required for the patient. The prescription needs match the date of service for the patient to be able to obtain the proper notes from the visit as well as what is needed for the patient. It is very important all the necessary documents are signed.