DME Documentation and Denied Claims

Is your DME documentation causing claim denials? Insurances are increasing the record request for higher cost products and becoming more stringent with their requirements. Help prevent unnecessary denials with these tips.

  1. Conservative treatment - The record should outline what conservative treatment was done prior to dispensing DME. This can be outlined in the current date of service note or by including previous treatment dates with the request

  2. Code narrative - Make sure the description of the product used matches the HCPCS code definition. For example- L1930- Ankle foot orthosis, plastic or other material, prefabricated, including fitting and adjustment. 

  3. Proof of delivery (POD) - The record must contain POD. You should create a template for in office pick up.  It should include the patient’s name, address product was picked up at, the date of pick up, quantity received, and the product they received. The HCPCS and description used in the record should match the product on this document. The patient must sign and date acknowledging receipt. For shipping/delivery to the patient the form must include patient’s name, delivery address, delivery service’s package identification number, detailed description of product, quantity received, date delivered and evidence of delivery (shipping confirmation)

  4. Legible and signed -  The record must be legible and signed by the treating provider.    

NOTE: Check your local coverage guidelines for the specific products being used.  The above is a guideline and not a guarantee of payment.

David SwierczDME documentation, denied medical claims, conservative treatment, code narrative