Claims Documentation Requirements

The DME MACs have standard documentation requirements for all claims submitted for payment. The requirements can be found in the Local Coverage Article (A55426.)

Individual LCDs/Policy Articles provide information about medical necessity and coding for the products associated with the topic of the articles. For example, you can learn which codes are appropriate to bill for specific K levels in the Lower Limb Prosthesis articles. The documentation required for all DMEPOS claims is in no longer listed in each LCD/Policy Article. One document, the Local Coverage Article: Standard Documentation Requirements for All Claims Submitted to DME MACS (A55426) provides a comprehensive review.

Medicare Auditors follow the documentation guidelines outlined in the article to determine if the submitted claim is to be paid.

What does this mean for you?

Access and download the Standard Documentation Requirements article and make sure you are following the process. A few of the requirements include:

• Signature and date stamps not allowed
• New orders required when an item is replaced
• DWO must have two dates; date of order and physician's signature date

Read the entire Local Policy Article here.