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Linda Collins Blogger

Three Items Needed for a Claim

Posted by Linda Collins | October 18, 2016

According to Medicare requirements, you must have a Detailed Written Order (DWO), appropriate documentation supporting the medical necessity of the item, and a Proof of Delivery (POD) in your files. Further, Medicare provides specific instructions about details needed in each.

Detailed Written Order (DWO)

This is essentially a document signed by the physician, which lists the relevant patient information and all the items being prescribed for the patient. A detailed written order (DWO) is required before billing. You, the supplier, may create the DWO as long as the ordering physicians reviews the content and signs and dates the document.  The DWO must contain:

  • Prescribing physician's name
  • Date of the order
  • Detailed description of the item(s)
  • Prescribing physician's signature and signature date

A few reminders:

  • If the supplier creates the DWO then the prescription must be reviewed and, "…personally signed and dated…" by the prescriber. In this scenario, two (2) dates are required: an "order date" and a prescriber-entered "signature date".
  • Signature and date stamps are not allowed.
  • The DWO must be available upon request.
  • A prescription is not considered as part of the medical record. Medical information intended to demonstrate compliance with coverage criteria may be included on the prescription but must be corroborated by information contained in the medical record.

Medical Record Documentation

The indications for coverage and the definitions of medical necessity, are outlined the LCDs and Policy Articles. These documents provide the requirements that must be met and documented in order for the claim to be paid.

A few reminders:

  • Supplier-produced records, even if signed by the ordering physician, and letters of medical necessity are considered not to be part of a medical record.
  • Templates and forms are subject to corroboration with information in the medical record.

Proof of Delivery (POD)

You are required to maintain documentation in their files that show the item(s) delivered are the same item(s) submitted for Medicare reimbursement and that the item(s) are intended for, and received by, a specific Medicare beneficiary.

The POD must include:

  • 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
  • Beneficiary (or designee) signature

A few reminders:

  • The signature and date the beneficiary must be legible.
  • The signature date/date of delivery becomes the date of service on the claim.
  • Proof of delivery documentation must be available to the Medicare contractor on request.

​What does this mean for you?

Review the LCDs for the devices you provide. Understand the coverage criteria and assure you and your referring physicians are providing sufficient documentation to meet the criteria. Check you DWO and POD documents for compliance. Follow the guidelines outlined in the LCDs to minimize your chances of not receiving payments for your services.

You may find the LCDs and Policy Articles on the DME MAC websites:

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