by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
According to MLN Connects 2022-04-21 MLNC, "For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient’s medical record must include enough documentation to justify the need for:
- Type and quantity of items ordered
- Frequency of use (or replacement if applicable)
The medical record should include the patient’s diagnosis and:
- Condition duration
- Clinical course (worsening or improving)
- Nature and extent of functional limits
- Other therapeutic interventions and results
- Experience with related items
The medical record may include records from hospitals, nursing facilities, home health agencies, and other health care professionals.
See Section 5.9 of the Medicare Program Integrity Manual, Chapter 5 (PDF) for more information."