CMS Pub. 100-08, ch. 5, § 5.10

A. General

Before submitting a claim to the DME MAC (or before dispensing the item – see section

5.2.4), the supplier must have on file a standard written order, the CMN (if applicable),

the DIF (if applicable), information from the treating practitioner concerning the patient's

diagnosis, and any information required for the use of specific modifiers or attestation

statements as defined in certain DME MAC policies. The supplier should also obtain as

much documentation from the patient's medical record as they determine they need to

assure themselves that coverage criteria for an item have been met. If the information in

the patient's medical record does not adequately support the medical necessity for the

item, the supplier is liable for the dollar amount involved unless a properly executed

ABN of possible denial has been obtained.

Documentation must be maintained in the supplier's files for seven (7) years from date of

service. If the provider responds, in writing, that the Medicare qualifying supplier

documentation is older than 7 years, and provides proof of continued medical necessity of

the item or necessity of the repair, the contractors shall not deny the claim based solely on

missing the supporting Medicare qualifying documentation that is over 7 years old.

B. Proof of Delivery

Section 424.57(c)(12) requires suppliers, as part of their standards to be met for

enrollment and participation, to maintain proof of delivery documentation in their files. In

certain instances, compliance with proof of delivery may be required as a condition of

payment, and must be available to the DME MAC, RAC, SMRC, CERT, and UPIC on

request. For such items, if the supplier does not have appropriate proof of delivery

documentation within the prescribed timeframes, associated claims will be denied and

overpayments recouped. We note that non-compliance with supplier standards may also

result in revocation from the Medicare program. Suppliers who consistently do not

provide documentation to support their services may be referred to the OIG or NSC for

investigation and/or imposition of sanctions. If the beneficiary is newly eligible to the

Medicare program, the proof of delivery standards require the supplier to obtain a

statement, signed and dated by the beneficiary (or beneficiary's designee), that the

supplier has examined the item.

Please refer to IOM 100-08. Ch. 4, Section 4.7.3.1 for additional information regarding

all proof of delivery requirements.