CMS Relaxes Documentation Requirements for DME Repair Claims

 

Acceptable Electronic Signatures

For electronically signed documents, such as medical records, Medicare requires that services provided/ordered be authenticated by the author. The following is a list of acceptable electronic signature verbiage that indicates the document has been electronically signed.

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CMS recently issued Change Request 8843 that provides additional guidance to the DME MACs when conducting medical review of DMEPOS repair claims.

Due to the changing environment occurring in the DMEPOS industry and the difficulties Medicare beneficiaries are having in locating suppliers to repair equipment when the original supplier's documentation for the equipment is not available, CMS is providing guidance as to what documentation is required when conducting medical review of DMEPOS repair claims. If Medicare paid for the base equipment initially, medical necessity for the base equipment has been established. Therefore, contractors are to only review the necessity of the repair and make a payment determination. The contractor shall ensure that the supplier's documentation records support the need to restore the equipment to functionality to meet the beneficiary's medical need. This guidance for repairs is to be applied to all DMEPOS equipment owned by Medicare beneficiaries effective for dates of service on and after November 4, 2014.

CMS Instructions to the DME MAC contractor:

  • Medicare contractors are to only review the necessity of the repair and make a payment determination.
  • Medicare contractors shall only assess the necessity of the DMEPOS repair when reviewing the claims and whether the equipment was fixed.

CMS Instructions to Audit Contractors (CERT, PSC, RA, ZPICs)

  • Medical Records are not required to address the medical necessity of the DMEPOS equipment as/when it was originally ordered but, shall address the continued medical necessity of the item and the necessary repair.
  • Medicare contractors shall not require a face-to-face examination for repair of DMEPOS items already covered and paid for by Medicare. However, documentation from the physician or treating practitioner that indicates the DMEPOS item being repaired continues to be medically necessary is required. Documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy.
  • Medicare contractors shall only apply this guidance when reviewing DMEPO claims for repairs of beneficiary’s owned equipment.
  • Contractors shall continue to adhere to the coverage and payment policies and procedures.


To read the change to the Medicare Program Integrity Manual, Chapter 5, Section .8.1 -  Suppliers Documentation for DMEPOS Repair Claims click here. 


    • Chart “Accepted by” with provider’s name
    • “Electronically signed by” with provider’s name
    • “Verified by” with provider’s name
    • “Reviewed by” with provider’s name
    • “Released by” with provider’s name
    • “Signed before import by” with provider’s name
    • Digitalized signature: Handwritten and scanned into the computer
    • “This is an electronically verified report by John Smith, MD”
    • “Authenticated by John Smith, MD”
    • “Authorized by: John Smith, MD”
    • “Digital Signature: John Smith, MD”
    • “Confirmed by” with provider’s name
    • “Closed by” with provider’s name
    • “Finalized by” with provider’s name
    • “Electronically approved by” with provider’s name


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