More than a 3×5

Being the daughter of a pharmacist, I have seen my fair share of 3×5s. The typical 3×5 prescription slip will have the beneficiary’s name, physician’s name, date of order and a description of the item being ordered. This information can be faxed over or taken verbally by an HME provider.

This is enough information for you to deliver HME equipment, but it definitely falls short of the information needed to be able to bill it. In fact, you may not want to deliver the equipment based on this basic information alone, as it is not nearly enough to establish the medical necessity required by Medicare guidelines. As you well know, if medical necessity guidelines are not met, the item is considered not reasonable and necessary — and will not be reimbursed.

A physician order should be used for each piece (or group) of equipment you deal with. Take the time to review the Medicare manual and make sure the form your staff is using includes the appropriate questions to help determine the medical necessity of the item that is being ordered. Each piece of equipment is different and, in most cases, a generic physician order will not provide enough detailed information.

The physician order should be to the point and easy for the physician to understand and fill out, while still getting all of the medical necessity information needed. If you do not wish to create your own form, there are several versions available for sale by different vendors.

Remember that if your personnel obtain all of the necessary information at the time of intake, they can complete the physician order; the physician will need only to sign and date the order stating that he or she agrees with the validity of the information.

There are some items that need to be included on all physician orders:

• Beneficiary name, address and health insurance claim (HIC) number
• Physician name, address and UPIN
• Diagnosis (ICD-9 code or narrative)
• Detailed description of item and related supplies, plus the quantity to be dispensed
• Frequency of use
• Length of need
• Physician signature and date signed
• Original start date
• Medical necessity must be documented

The only way to establish medical necessity and have the proper documentation is to have a proper physician order filled out for the equipment, and to have the physician review and sign it.

If additional documentation is required, the physician should attach it at the time he or she signs. If the documentation is not attached when you receive the signed order, call the doctor’s office and request it. Don’t wait until an audit to try to get any additional documentation as it will be difficult — and maybe impossible — to obtain at that point.

There are also some items that require a written order prior to delivery. In these cases, a verbal order from the physician is not enough for you to deliver the equipment. You must obtain the WOPD, either a faxed copy or an original, prior to delivery of the item. The items requiring a WOPD are:

• Decubitus care products (includes all wheelchair cushions)
• Seat lift mechanisms
• Transcutaneous electrical nerve stimulator (TENS) units
• Power operated vehicles (POVs)

It is vital that the WOPD be in your hands before the equipment/supplies leave your showroom floor or warehouse. There should be a written policy and procedure in your company to audit this paperwork prior to delivery. If there is not, then write one and educate your staff accordingly.

Intake is everything! You hear me scream about intake at every seminar and explain its importance constantly. Everything starts at intake — and can end at intake. As you see, intake even decides assignment of an item as well as determining medical necessity.

Make sure your intake employees understand what information needs to be obtained so they get the proper information up front to make sure your physician orders are audit-friendly and decrease days sales outstanding in the end.

Jane Bunch is vice president, HME consulting, for Atlanta-based CareCentric. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans and serves as a consultant for fraud and abuse cases. She can be reached at 678/264-4495 or via e-mail at [email protected].