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Doctor's Order/Prescription Guidelines

As you know, when a physician would like his/her patient to have a specific piece of equipment or supplies, he will write out an order for it. What you may not know is that Medicare has particular requirements for the information that must be included in the doctor's order. If the information is not included, Medicare may deny the claim. There is good news, though, because if the physician does not complete an order correctly, you can send one to him/her and have him/her sign off on the correct information.

Here is the list of information that is required by Medicare:

• The patient's name
• The patient's address
• The patient's HICN
• The patient's diagnosis, either a written description or the ICD-9 code
• A detailed description of the item(s) that the doctor is prescribing, including quantity and frequency of use, if supplies
• The length of time that the patient will need the item
• The physician's signature (not a stamp)
• The physician's UPIN
• The date that the equipment was prescribed

If Medicare audits you and any part of this information is not on the corresponding prescription, they may request that you refund to them any money paid. To be sure this does not happen, make sure that each order you receive has this information. If you receive incomplete orders, you may use your billing software or create your own order that may be filled out and sent to the physician (similarly to a CMN), for him/her to sign and date. Remember that the date that the item was provided must be on the order, in addition to the date that the physician signs it.

Also remember that if the item(s) that you provide to the patient is the result of a verbal order (over the telephone), there must still be a written follow-up from the physician. It is your duty to see that this order is obtained and placed in your files. If a CMN is required, this can serve as the doctor's written order; however, if it is not, you will need to have a complete written order with the above elements in your file.

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