Billing: Meet all requirements

Q. Can there be a review on continued medical need vs. continued use and the requirements?
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Wednesday, August 29, 2018

A. For ongoing supplies and rented DME items, in addition to information justifying the initial need of the items and/or supplies, there must be information in the medical record to support that the item continues to remain medically necessary. Suppliers are responsible for monitoring utilization of rental items and supplies. Timely documentation is within the preceding 12 months—keep this in mind throughout the article.

Continued Medical Need

Recent order by the treating physician for refills

Recent change in prescription

Properly completed CMN/DIF with an appropriate length of need specified

Documentation in the beneficiary’s medical record showing usage

Continued Use

Refill requests

Supplier records documenting beneficiary confirmation of use

Delivery ticket showing refill of supplies, maintenance on equipment, or repairs

Monitoring of purchased items or capped rental items that have converted to a purchase is not required. Suppliers must discontinue billing Medicare when rental items or ongoing supply items are no longer being used.

Obtaining the proper medical records from the treating practitioner offers its own challenges. More than likely, DME will not be mentioned. One way to obtain the documentation is by collaborating with hospitals and physician to implement DME into the EHR. Whether DME is listed in the medication list or another area could serve as a reminder to address the continued need.

There are many states that have laws requiring annual orders on supply type items and some DME items. Obtaining an annual order will help meet both the state law and continued medical need requirements.