What Documentation Does Medicare Require for Durable Medical Equipment?

One of the most common reasons a durable medical equipment request is delayed is incomplete documentation.

A prescription is important, but Medicare may require additional information to establish that the equipment is medically necessary and satisfies applicable coverage requirements.

Standard Written Order

Standard Written Order

Medicare requires a Standard Written Order (SWO) for DMEPOS claims.

To help facilitate a patient’s durable medical equipment (DME) order, a complete Standard Written Order (SWO) and accurate supporting documentation are required. Vital Doctors Medical Equipment provides an SWO template and other helpful forms and resources on our Patient & Healthcare Resources page.

The SWO generally includes:

• Beneficiary name or Medicare Beneficiary Identifier

• Order date

• Description of the item

• Quantity, when applicable

• Treating practitioner’s name or NPI

• Treating practitioner’s signature

For equipment, the order may also identify separately billed options, accessories or additional features.

Medical Records

Medical Records Request

The medical record is often critical.

Documentation should support why the equipment is reasonable and necessary for the individual patient.

Depending on the equipment, relevant records may include:

• History and physical examination

• Progress notes

• Diagnoses

• Functional limitations

• Treatment plans

• Relevant testing

• Mobility limitations

• Why alternative equipment is insufficient

• Specific positioning or other medical needs

A diagnosis by itself may not demonstrate why a particular item of equipment is medically necessary.

Face-to-Face Encounter

Certain DMEPOS items require a qualifying face-to-face encounter.

Face to Face Documentation

For items subject to this requirement, CMS generally requires the practitioner visit to occur within six months before the order.

The encounter should gather and document information related to the condition for which the equipment is being ordered.

Different or additional requirements may apply to particular equipment.

Written Order Prior to Delivery

Certain DMEPOS items require a complete written order before the equipment is delivered.

Other DMEPOS items require the order before the Medicare claim is submitted.

That’s why healthcare providers and DME suppliers need to identify the requirements for the specific equipment being ordered.

Prior Authorization

Certain DMEPOS items are also subject to prior authorization.

Prior authorization allows Medicare to review documentation before the equipment is furnished.

Power mobility devices are an important example.

Proof of Delivery

DME suppliers must also maintain documentation showing that covered equipment was delivered.

Proof-of-delivery records are part of Medicare’s documentation requirements and must be retained by the supplier according to applicable rules.

How Healthcare Providers Can Help Prevent Delays

When prescribing DME, detailed patient-specific documentation can help.

Instead of simply documenting:

“Patient needs wheelchair.”

the medical record should describe the patient’s actual functional limitation and why the prescribed equipment is medically necessary, when applicable.

DME Documentation Assistance in San Antonio

Vital Doctors Medical Equipment works with patients and healthcare providers throughout San Antonio to help coordinate DME documentation.

Our Patient & Healthcare Resources Section provides information and forms designed to make the process easier for patients, physician offices and other healthcare professionals.

Requirements vary by equipment and payer. Documentation does not guarantee coverage or payment.