FLASH: Medicaid Guidelines for Durable Medical Equipment (DME) Supplies

As a reminder, Health Alliance follows the Medicaid guidelines for DME supplies.

Medicare Program Integrity Manual 5.2.8

Providers who dispense equipment or supplies on a monthly basis must confirm orders each month prior to dispensing. The confirmation should document the number of items needed as well as the name of the specific items needed for the subsequent month. Providers must speak to a patient, family member, or caregiver to ensure only those items and quantities needed are shipped. Orders not confirmed should not be dispensed. Confirmation calls must be made no more than 14 calendar days before the scheduled shipment day of the equipment or supply items.

Medicare Program Integrity Manual 5.8-B

Suppliers are also required to maintain proof of delivery documentation in their files. Proof of delivery is required in order to verify the participant received the equipment or supply items.

Medicare DMEPOS Supplier Standards

Note: This is a Medicare DME supplier standard and can be used as a program integrity measure when an onsite audit occurs.

In the case of medical supplies, the provider must be able to document purchases of sufficient quantities of the items to support the volumes dispensed and billed. In the case of DME or prostheses, the provider must be able to provide a copy of the original wholesale purchase invoice for the item and records of any customization performed by the provider.