Medicare Rules Contributing to a Fraud Free DME Billing!

• Other medical records (history, physical examination, tests, findings, diagnoses, treatment plans) and PMD prescriptions must also be furnished. Just a sign from the practitioner does not suffice.

• The supplier must submit this documentation to CMS or its agents for validation.

• For coverage by Medicare, the medical records must also specify the type and quantity of items claimed, duration of the condition, clinical course, prognosis, nature, and extent of functional limitations, other therapeutic interventions and results, and past experience with related items (compliance.com).

• The patient’s record could also be from a hospital, nursing home, health agency, etc.

• If there are no authentic documents, and unless an executed ABN has been furnished of possible denial, the supplier is accountable for DME. Hence the supplier should furnish the maximum information available and maintain it for 7 years.