January Educational Update
Completing an Accurate Letter of Medical Necessity
National and local Medicare policy specifies that upon complete of a face-to-face examination, the treating practitioner or physician must complete a written order containing seven specified elements. As the supplier of these services you may choose to provide physicians with a form that outlines the necessary fields to ensure the necessary requirements are met.
If you submit an LMN without proper documentation the claim will not be processed and you will NOT be paid on the claim. In order to ensure efficiency’s before submitting a claim, be sure to check that the LMN contains the following;
1. Beneficiary Name
2. Item Ordered
3. Date of Face-to-Face Examination
4. Diagnosis/Condition Relating to Need for Item
5. Length of Need
6. Physician Signature
7. Signature Date
It is not permissible for a supplier to “lead” the referring physicians as to the type of equipment rendered. No forms should be pre-inscribed with items ordered or any other pertinent information. An example of what not to do includes but is not limited to;
• A form with “Power Mobility Device” already entered in the “Item Ordered” field.
• A form that contains check boxes for certain items.
New Requirement of a Face-to-Face Encounter Prior to Ordering DME
Effective July 1, 2013, in accordance to rules governed by Medicare and Medicaid, orders for durable medical equipment (DME) must include physician documentation that a face-to-face encounter with the patient occurred during the previous six months.
What does this mean for DME Suppliers?
Beginning July 1, 2013, DME Suppliers must obtain a written order and supporting documentation from the treating physician indicating that a healthcare practitioner had a face-to-face encounter with the beneficiary within a period no greater than the previous six months.