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Documentation

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 …

Types of Medical Equipment

  • Wheelchairs
  • Hospital beds
  • Oxygen
  • Nebulizers
  • Cervical traction
  • Lift chairs
  • Special mattresses
  • Gel overlays
  • BiPAP or CPAP
  • Lymphedema pumps
  • TENS units
  • Infusion pumps

DWO

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

Face-to-Face

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

Oxygen

  • 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.

PAP Devices

  • 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