In order to bill insurance, we need to have a complete physician’s prescription. This includes the patient name, a description of the prescribed item, physician signature and date.
The following types of medical equipment now require a Detailed Written Order (DWO) prior to dispensing the item. The DWO must include the physicians printed name and NPI …
- Hospital beds
- Cervical traction
- Lift chairs
- Special mattresses
- Gel overlays
- BiPAP or CPAP
- Lymphedema pumps
- TENS units
- Infusion pumps
The Detailed Written Order must contain the following:
- Beneficiary’s name
- Date of order and start date, if different from date of order
- Detailed description of the item(s) being ordered
- Route of administration, Pressure settings
- Frequency of use
- Length of need
- Treating practitioner’s printed name and NPI
- Treating practitioner’s signature and date
In addition, face-to-face documentation, a documented physician appointment, must be completed prior to dispensing the following items. The face-to-face must include a discussion about the need for the specifically prescribed medical equipment.
- Power and tilt wheelchairs
- Oxygen – within 30 days of the initial setup
- BiPAP or CPAP
- Group 1 – oxygen saturation is 88% or less on room air
- Group 2 – oxygen saturation is 89% or higher with one of the following diagnoses: Chronic Heart Failure (CHF), Pulmonary HTN or Cor Pulmonal
- If portable oxygen is being ordered, there needs to be documentation in the medical records indicating the patient is mobile within the home
- Portable oxygen is considered when the blood gas study is performed while patient is awake or with exercise. At night use only does not qualify for a portable unit.
- A frequency of use must be indicated, i.e. 2 lpm continuous or 3 lpm at night.
- Recertification by treating physician documenting patient is benefiting from the oxygen therapy and has shown improvement. Recertification is required after 12 months of initial certification for Group 1; and after 3 months for Group 2.
- Compliance must be documented. Adherence to therapy, reviewed by the treating practitioner is using the PAP a minimum of 4 hours per night on 70 percent of nights during a consecutive 30 day period during the first 3 months of therapy