At the Sept. 13 special Open Door Forum on the rule, Centers for Medicare & Medicaid Services said though the prescription does not have to be on any sort of standard form, it does have to contain the following elements:
1. The beneficiary's name;
2. The date of the face-to-face exam;
3. The diagnosis that the device is expected to modify;
4. A description of the item;
5. The length of need;
6. The physician's signature; and
7. The date the prescription was written.
CMS officials cautioned suppliers against providing pre-printed forms to physicians, because such forms would raise kickback concerns. But collaborating on a form would be OK, they said.