DME MAC JURISDICTION C - CGS

Supplier Documentation Chapter 3A new order is required when an item is being replaced because the item is worn or the patient’scondition has changed. The supplier’s records should also include beneficiary-specific informationregarding the need for the replacement item. This information should be maintained in the supplier’sfiles and be available to the DME MAC or DME PSC on request. Failure to provide the appropriatedocumentation or providing documentation that contains broad, nonspecific explanations will resultin claim(s) denial.A new physician’s order is required before replacing lost, stolen or irreparably damaged items toreaffirm the medical necessity of the item. Proof of loss or damage through documentation such as apolice report, picture, or corroborating statement should be submitted with the claim.For items that require a Certificate of Medical Necessity (CMN), the CMN may serve as the writtenorder if the narrative description in Section C is sufficiently detailed. If the item is one which requiresa written order prior to delivery, and the supplier uses the CMN as the written order, the suppliermust have received the fully completed CMN (original “pen and ink,” electronically maintained,photocopy, or facsimile image) before dispensing the item. For accessories, supplies, and drugsrelated to an item requiring a CMN, the CMN may serve as the written order if the narrativedescription in Section C is sufficiently detailed.Nurse Practitioner or Clinical Nurse Specialist Rules Concerning Orders andCMNsA nurse practitioner or clinical nurse specialist may give the dispensing order and sign the writtenorder in the following situations:• They are treating the beneficiary for the condition for which the item is needed;• They are practicing independently of a physician;• They bill Medicare for other covered services using their own provider number; and• They are permitted to do all of the above in the State in which the services are rendered.A nurse practitioner or clinical nurse specialist may complete Section B and sign Section D of a CMNif they meet all the criteria described above for signing orders.Physician Assistant Rules Concerning Orders and CMNsPhysician assistants may provide the dispensing order and write and sign the written order if theysatisfy all the following requirements:• They meet the definition of physician assistant found in §1861(aa)(5)(A) of the Act;• They are treating the beneficiary for the condition for which the item is needed;• They are practicing under the supervision of a Doctor of Medicine or Doctor of Osteopathy;• They have their own UPIN; and• They are permitted to perform services in accordance with State law.Physician assistants may complete Section B and sign Section D of a CMN if they meet all thecriteria described above for signing orders.DME MAC Jurisdiction C Supplier Manual Page 8