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Linda Collins Blogger

1,2,3 for Orthoses Claims Billing

Posted by Linda Collins | July 15, 2014

Do you know what documents you must have in your files prior to submitting a claim? In addition to chart notes, letters of medical necessity, and medical records you must have the following:

1. Dispensing Order (verbal or written)

This is the initial prescription or request to evaluate the patient. The actual order or the note supporting the verbal order must include:

  • Description of the item
  • Name of the beneficiary
  • Name of the physician
  • Start date of the order

Every Orthoses claim must have a Dispensing Order on file in order to be valid.

2. Detailed Written Order (DWO)

This final prescription includes detailed information about the patient, diagnosis, item dispensed and ordering physician. The DWO can be created by someone other than the physician as long as the physician signs and dates the document. The DWO is required to have the following elements:

  • Beneficiary's name
  • Detailed description of the item(s) to be dispensed (The detailed description in the written order may be either a narrative description or a brand name/model number.)
  • Treating physician's signature (Signature and date stamps are not allowed.)
  • Date the treating physician signed the order
  • Start date of the order - if the start date is different than the signature date

See “DWO =Detailed Written Orders” post from February 17, 2104 for additional information.

3. Proof of delivery

The patient signs this document at time of product delivery. It confirms the patient received the specific product on the designated day. A signed and dated delivery slip offers proof of delivery if it contains sufficient detail to identify the items and verify that they were correctly coded.

The Proof of Delivery includes:

  • Beneficiary’s name
  • Delivery address
  • Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
  • Quantity delivered
  • Date delivered, which is the date of service on the claim
  • Beneficiary (or designee) signature and date of signature (must be legible)

The post “Proof of Delivery 1-2-3” from March 3, 2014 offers additional information.

One final reminder, submit the claim to the appropriate Medicare Administrative Contractor (MAC) or private insurer. Medicare reports that one of the top reasons for claims denial is due to the incorrect mailing address for submission.

DME Medicare Administrative Contractors

Region A:

Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

Region B:

Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin

Region C:

Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

Region D:

Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming

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