Medicare Compliance & Reimbursement

Question: I’m a newbie to durable medical equipment (DME) and not exactly sure what we need to provide Medicare as far as documentation goes, or exactly how long we need to keep the documentation after billing. I’ve heard there are different requirements and different timeframes depending on the delivery method. Can you help clarify please?

Pennsylvania Subscriber

Answer: It’s good that you are seeking clarification as the Comprehensive Error Rate Testing (CERT) Task Force has consistently identified missing or incomplete proof of delivery (POD) documents on DME claims. It is more important than ever to know exactly what documentation is needed for the different delivery methods and how long it must be kept.

Proof of delivery can include:

• Beneficiary’s name
• Delivery address
• Quantity delivered
• Date delivered
• Description of the item delivered (This description must include one of the following):
  • Narrative description
  • HCPCS code
  • Long description of a HCPCS code
  • Brand name and model number

The specific items required do vary based upon the delivery method. The Centers for Medicare & Medicaid Services (CMS) provides a CERT DME POD Requirement Work Guide, which defines exactly what’s required for each type of delivery method.

To answer the second part of your question, there is no difference as to how long the documentation must be kept. CMS requires POD documentation be maintained for seven years after the date-of-service no matter what delivery method is used.

For guidance on all the requirements necessary to ensure DME payment take a look at this CMS article (A55426). And, find more details about DME, including clarification of the different types of items and services, at CMS’ Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) webpage.

Patricia Zubritzky, BS, CRCE-I, Contributing Writer, Pittsburgh