Updates from CGS Medicare on DMEPOS for Suppliers in N.C., S.C., Va., W.Va.

Published 09/03/2024

CGS Medicare continues to provide information and tools aimed at reducing the burden on suppliers and practitioners. Our objective is to process claims timely and correctly for the items you are prescribing for your Medicare beneficiaries. We ask that you work with the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier to ensure the documentation supports the items prescribed. The collaboration between CGS and the AB MACs is ongoing to provide education on what is needed to document the medical necessity for items of DMEPOS. 

When the DMEPOS supplier requests medical records and documentation from the treating practitioner, they are simply trying to ensure the beneficiary’s condition(s) meets the requirements outlined in the Local Coverage Determination (LCD) and related policy article. If the supplier is not able to provide the supporting documentation for the items prescribed, the beneficiary could be responsible for paying for the item or delayed in receiving it. 

These are some of the errors CGS continues to see when it comes to documentation: missing or incomplete orders, no medical records submitted, same or similar items in use, and the medical records do not support the items prescribed. The request for additional information or medical records from the DMEPOS supplier is to obtain the necessary documentation in support of the items prescribed. Please respond quickly and completely to these requests for information. The DMEPOS supplier is attempting to provide the prescribed items timely to the beneficiary and receive payment for their service. 

Treating Practitioners and Prescribers DMEPOS Education

CGS created dedicated web pages as part of the continued collaboration between the A/B and DME MACS. Suppliers may provide the treating practitioners with links or references to these pages to obtain needed information. These resources were created by physicians for physicians with the goal of assisting prescribing practitioners with the documentation needed and why. The resources available include the "Dear Physician" letters, “Physicians! Are You Ordering…" articles, and information on previously conducted collaborative webinars.

The Physician's Corner is another resource that contains information relevant to physicians and suppliers to assist with the types of documentation needed. Links are available to letters, videos and articles that are physician-focused. 

DME MACs Medical Review Targeted Probe and Educate (TPE) Reviews
The Medical Review department at CGS continues the TPE reviews on selected items to confirm documentation requirements are met. In this situation, the DMEPOS supplier may reach out to the treating practitioner for additional documentation to support the item(s) prescribed. If contacted, please respond to the request within the timeframe specified by the supplier. 

Commonly Used References from the CGS Website

The Documentation Checklists are provided to assist suppliers with what is needed for compliant documentation. These checklists are policy specific and created using information found in the corresponding LCD and policy articles. Suppliers use these checklists to verify if all documentation elements are met. The documentation checklists are revised or added based on feedback from suppliers or updates to the medical policy. 

The Local Coverage Determinations (LCDs) are developed jointly by the DME MACs. The DME MACs have the authority and responsibility to establish LCDs when there’s no national policy on a subject or when there’s a need to further define a National Coverage Determination or NCD. The DMEPOS supplier may refer physicians to this page to assist with clarification on a policy or what documentation is needed to support the item or equipment prescribed. 

  • Here are self-service options to assist will documentation gathering and claim submission:
  • If you have ideas or suggestions on how CGS can improve the type of education we provide on DMEPOS items and documentation needed, please contact us using the following:

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