Documentation Tips for Ostomy Supplies

March 8th, 2018 - Medicare Learning Network
Categories:   Documentation Guidelines   Denials & Denial Management  

The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies:

To Prevent Denials
Include the following elements in submitted documentation:
1. Dispensing order description of the item
  • Beneficiary name
  • Prescribing physician name
  • Date of the order and the start date, if the start date is different from the date of the order
  • Physician signature (if a written order) or supplier signature (if verbal)
2. Detailed Written Order (DWO)
  • Beneficiary name
  • Physician name
  • Date of the order and the start date, if start date is different from the date of the order
  • Detailed description of the item(s)
  • Physician signature and signature date

3. Beneficiary Authorization

4. Refill Requirements
  • A routine refill prescription is not needed; a new prescription is needed when:
    • There is a change of supplier
    • There is a change in the item(s), frequency of use, or amount prescribed
    • There is a change in the length of need or a previously established length of need expires (state law requires a prescription renewal)
5. Proof of Delivery (POD) 
  • Suppliers are required to maintain POD documentation in their files
6. Evidence of continued medical need
  • Initial justification for the medical need is established at the time the item(s) are first ordered
7. Evidence of continued use
  • Continued use describes the ongoing utilization of supplies or a rental item by a beneficiary
The following reminders will help you comply with Medicare ostomy supply coverage requirements:
  1. Medical records must contain adequate, clear documentation that corroborates the medical necessity of the amount ordered and billed.
  2. Ostomy supplies are not separately payable when a beneficiary is in a covered home health episode. The home health agency must provide the ostomy supplies, and payment is included in the home health Medicare payment rate.


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