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- Patient demographic information, including insurance information
- Height and weight to ensure equipment can be fitted properly
- History and physical from the medical record
- Progress notes indicating medical necessity for prescribed medical equipment
- For respiratory equipment, we will need respiratory settings (e.g., Oxygen 2 lpm continous via nasal cannula)
- Physician information
How do I send a referral?
What is the turnaround time for a referral?
We will contact the patient to schedule delivery within 48 hours, pending complete information, including signed orders.
On July 1, 2013, section 6407 of the Affordable Care Act established operational protocols necessary to comply with face-to-face encounter requirements for certain DME items. The law states that:
- A patient encounter must occur within six months prior to the order being written for DME.
- A physician, nurse practitioner, physician assistant or clinical nurse specialist must have a face-to-face encounter with the patient.
- If the face-to-face encounter has occurred within six months and is completed by a physician assistant, nurse practitioner, or clinical nurse specialist, the physician must cosign and date the pertinent portion of the face-to-face encounter.
What must be documented in the face-to-face encounter?
Beneficiary was evaluated and/or treated for a condition that supports the DME ordered.
What must be on the written order prior to delivery?
- The beneficiary’s name
- DME item(s) being ordered
- The prescribing practitioner’s National Provider Identifier (NPI)
- The signature of the ordering practitioner
- The date of the order
What DME items require a face-to-face and a written order prior to delivery?
- Bilevel positive airway pressure
- Cough assist
- Hospital beds
- Oscillatory devices
- Seat lift
- Traction devices
- Wheelchairs and accessories
Who can sign a written order prior to delivery?
- Nurse Practitioner
- Physician Assistant
- Clinical Nurse Specialist
- Any of the above can sign the written order prior to delivery as long as that provider has a NPI and is enrolled in PECOS
What is PECOS?
PECOS stands for Provider Enrollment, Chain and Ownership System.
PECOS is a way for health care providers to modify their provider file online. It is designed to check the provider credentials before Medicare claims are paid.
Which delivery options are available?
- Home delivery
- In-store pick up
For other equipment forms, please contact our office at 920.568.9860.