Thursday, February 6, 2014

Detailed Written Order Requirements

As a requirement of the Affordable Care Act, which went into effect on July 1, 2013, and Medicare began enforcing on January 1, 2014, whenever prescribing specific DME items (see list below) for Medicare patients, you must:
  • Document in progress notes that the patient has had a face-to-face encounter with a practitioner (physician, PA, NP, or CNS) and was evaluated for a condition that supports the DME ordered.
    1. Face-to-face encounters occurring within 6 months prior to the prescription date are admissible IF they document the condition for which the prescription is being written.
    2. If the DME is ordered by a PA, NP, or CNS, a physician must document the occurrence of the face-to-face encounter by co-signing and dating the pertinent portion of the medical record.
  • Write a prescription containing the following elements:
    1. Patient’s name
    2. Physician’s name
    3. Date of the order and the start date, if the start date is different from the signature date
    4. Detailed description of the item(s)
    5. Physician signature and signature date (Signature or date stamps are not allowed)
    6. Prescribing practitioner’s NPI number
    7. Route of administration (nasal cannula, mask, etc.)
    8. Dosage, Concentration, or Liter Flow
    9. Frequency of use (continuous, nocturnal – PRN or as needed are not acceptable)
    10. Diagnosis is not required but highly recommended.

Equipment cannot be delivered until the Face-to-Face and Physician's Detailed Written Order are received by the DME provider as Medicare requires it prior to delivery.   

Please note for oxygen therapy patients, Medicare also requires that a saturation test be taken within 30 days prior to the delivery of the equipment. This test cannot be taken by Skilled Nursing Facility staff. If the test is taken during a hospital stay, it must be within 2 days of discharge.

Procedure Codes that NRS provides that are included in the new requirements:
  • Nebulizers: E0570, e0575, E0580, E0585, K0730
  • Oxygen:  E0424, E0431, E0433, E0434, E0439, E0441-E0444
  • Positive Airway Pressure Devices:  E0601, E0470
  • Respiratory Assist Devices:  E0470-E0472
  • Ventilators: E0450, E0460, E0461, E0463, E0464

Links for further information about the Detailed Written Order and Face-to-Face requirements:

From CMS