The four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have recently released a revised version of the “Dear Physician” letter that addresses the need for prescribing physicians to support the medical necessity of the DMEPOS services they prescribe through proper clinical documentation in the patient’s medical record. While the revisions to the Dear Physician letter were not significant from previous versions of the long-standing letter, the revision provides a reminder that for DMEPOS items or services to be covered, they must always be supported by physician documentation.
O&P won a battle in February 2018, with the enactment of Section 50402, which recognized the clinical notes of orthotists and prosthetists as part of the medical record for purposes of medical necessity determinations. While the legislative change essentially reset the clock back to 2011 and reversed the now retired Dear Physician letter for lower limb prostheses that said that O&P notes were not considered part of the medical record, Section 50402 DID NOT convey to O&P prescribing rights and DID NOT eliminate the need for physician notes supporting the medical need for O&P services they prescribe. Section 50402 specifically indicates that while orthotist and prosthetist notes are now part of the medical record, they are corroborative, and cannot, standing alone, trigger a finding of medical necessity.
The recognition of orthotist and prosthetist notes as part of the medical record is a long sought-after result, and one of great pride for AOPA but it is important to remember the crucial role of physician partners in documenting the medical need for O&P services they prescribe.
The revised Dear Physician letter regarding general documentation was just one of many minor revisions made to the Dear Physician letters. Most of the revised Dear Physician letters do not apply to O&P services. This includes the recently revised Dear Physician letter regarding face-to-face visit and written orders prior to delivery for certain DMEPOS items. It is important to remember that these specific requirements do not apply to O&P services as O&P services are specifically exempt from these requirements.
AOPA continually monitors the DME MAC websites for substantive changes to the Dear Physician letters that affect O&P providers and will communicate them to AOPA members immediately.
The revised Dear Physician letter on general documentation requirements may be viewed by clicking HERE.
Questions regarding this issue may be directed to Joe McTernan at firstname.lastname@example.org or Devon Bernard at email@example.com