Medicare program integrity manual

In addition, there may be state laws, rules or regulations governing the valid length of a prescription. Question 7: With respect to the "quantity to be dispensed, if applicable" requirement on the SWO, would it suffice to state that the quantity is "2 per day" or does the quantity have to read a specific number for a month supply, e.

DME MAC Response: Either description of quantity would suffice; however, for claim review purposes, expressing the quantity as a weekly or monthly amount is preferable. Note that the "if applicable" applies to drugs, dressings and other DMEPOS items where the dispensed quantity is typically more than one 1 item or that dispensing happens on a recurring basis.

Will the patient's primary care practitioner be considered the "treating practitioner" for subsequent supply orders? Question 9: For items subject to the face-to-face encounter and written order prior to delivery requirement, must the SWO be signed by the same treating practitioner who completed the face-to-face encounter? For items other than power mobility devices that will appear on the "Required Face-to-Face Encounter and Written Order Prior to Delivery List," the treating practitioner that conducted the face-to-face encounter does not need to be the prescriber for the DMEPOS item; however, to demonstrate compliance with the regulation, the prescriber must:.

Question If a patient experiences a change in treating practitioners, and a SWO is generated by the patient's supplier that prepopulates the wrong treating practitioner's name, is it acceptable for the supplier to strike through the wrong name, fill in the correct name, sign and date the change and submit the corrected order to the patient's treating practitioner for signature?

Question I am a treating practitioner but also a supplier. The SWO regulations do not require that a treating practitioner e. Physicians typically do not include the prescribing practitioner's NPI in the medical records. If the treating practitioner's name is included in the medical records, there is no need for the NPI to be included as well. CMS will provide a minimum of a day notice in the Federal Register for items appearing on either list.

Question For power mobility devices, are suppliers permitted to use a template for the SWO, like the previous 7-element order 7EO template, so long as the information is completed by the treating practitioner? A supplier may create a template for use by the treating practitioner to complete the SWO elements. For items other than power mobility devices, the supplier may prepare the SWO for the treating practitioner's signature. Question The final rule indicates there must be a face-to-face encounter with the treating practitioner within 6 months prior to the SWO being written for PMD.

The final rule CMSF defines a face-to-face encounter as an in-person or telehealth encounter, and defines a treating practitioner as both physicians, defined in section r 1 of the Act, and non-physician practitioners that is, PA, NP, and CNS defined in section aa 5 of the Act. To accommodate the requirements at 42 CFR If the treating practitioner chooses to refer the beneficiary to an LCMP for a mobility evaluation, the treating physician's co-signature, dating and indicating agreement or disagreement with the LCMP evaluation must occur within this six 6 month timeframe.

In this situation, regardless of whether the DMEPOS items are prescribed on different dates, the single face-to-face encounter may be utilized in support of the multiple items, if the encounter date is within 6 months of the orders.

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