Recently we have been getting a lot of questions about what the documentation requirements are for diabetic supplies to satisfy Medicare audits.
Here are some key things Jeff has found:
- Refills have to be documented whether the refill request was called in or the request was made in person
- Authorized Representative: must provide signature, printed name, relationship to patient, and indicate the patient was either physically or mentally unable to sign for the product
- Must record: Make; Model; Serial Number; Lot Number; and Expiration Date of product dispensed
- Prescriptions are only valid if the patient has been seen by their physician within the preceding six months
- If physician orders are greater than the allowable, the prescription is only valid for six months. In addition, a CMN or Detailed Written Order must be signed by the physician prior to billing Medicare
- If the pharmacy uses eRx Network (Allwin) or OmniSys, the patient must pick up the Rx on the date the label is printed. If the Rx is run and label printed on Monday, but the patient does not come in until Tuesday, CMS will pull back the reimbursement because the date of service started prior to the actual pickup date.
- Diabetic Testing logs:
- Must be obtained for all Medicare patients
- Patient testing must match the prescription
- If patient is testing within the allowable, you must be able to prove need of refill
- If patient is non-compliant with physician’s order, fill the Rx for the actual usage and zero out the refills. Patient must see physician to seek a new prescription
