Documentation Required for Insurance Billing

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Documentation Requirements for DME

Documentation Requirements for DME As a condition for payment, the Affordable Care Act (ACA) requires a physician to document that a face-to-face encounter/evaluation took place by a Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), or physician in the six (6) months prior to the written order for certain items of DME. Note that the written order must not be prior to the date of the face-to-face encounter. In the case of the Durable Medical Equipment (DME) ordered by PA, NP, or CNS, a physician (MD or DO) must document the occurrence of a face-to-face encounter by signing/co-signing and dating the pertinent portion of the medical record.

The Written Order Prior to Deliver (W.O.P.D.) rule states that a DME provider may not dispense the item until the physician's signature is in place for a list of 166 DME items. More detailed information follows:

Face-to-Face Visit Requirements

Written Order Prior to Delivery


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