CMS offers written assistance to aid in obtaining proper documentation

Early this week, CMS released physician letters of instruction defining the physician’s obligation by law to comply with documentation requests. Signed by Dr. Adrian M. Oleck, these letters are intended for use by providers when they find it difficult to obtain the proper documentation required to supply their patients with the equipment and services they need.

Obtaining Medical Necessity Documentation from Physicians

National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has received several inquiries in regards to suppliers having difficulty obtaining medical necessity documentation from the treating physician. Some suppliers are unable to receive the documentation due to the physician’s refusal to release the medical records.

To assist suppliers in obtaining medical necessity documentation from the physicians, the Medicare contractors have developed letters to aid in obtaining these records. These letters should be used when trying to obtain medical records from the physicians. The letters provide an explanation of the physician’s obligation by law to provide the requested medical records to the supplier.

Suppliers are encouraged to utilize the following letters:

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) – Physician Documentation Letter

http://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/MD%20Documentation.pdf.

Power Mobility Devices – Physician Documentation Letter

http://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/PMDDocument_DearPhysician.pdf.

Positive Airway Pressure Device – Physician Documentation Letter

http://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/Positive%20Airway%20Pressure_PAP_Devices_for_Obstructive_Sleep_Apnea_Letter.pdf.

Suppliers are also encouraged to get the beneficiary involved.  The beneficiary can contact their physician to request the medical records that are needed.

If all avenues have been exhausted and the physician is not cooperating, suppliers do have the option to report the physician to the Program Safeguard Contractor (PSC). The report should be made in the state in which the physician practices in.

For the states of Ohio and Kentucky, AdvanceMed is the PSC. Reports can be filed at: http://www.csc.com/advancemed/contact_us

For the states of Illinois, Indiana, Wisconsin, Minnesota, and Michigan, Trust Solutions is the PSC.  Reports for TrustSolutions can be filed via on-line, mail, or fax.

By Mail:

TrustSolutions, LLC
6775 West Washington Street
Milwaukee, WI 53214

By FAX:
(414) 459-2857

Some policies require that suppliers have specific medical documentation on file prior to submitting a claim to the DME MAC. Please be sure to refer to each individual medical policy to verify the documentation requirements, modifier usage and coverage criteria.

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