Standard Documentation Language for Local Coverage Determinations and Related Policy Articles - Joint DME MAC Publication

Note: This is a revision to the previous article published in November 2015. This version updates the requirements for orders and face-to-face examinations, in compliance with the Affordable Care Act (ACA) Section 6407. While the Standard Documentation language makes reference to "ACA 6407 requirements", technically these requirements are found in the Social Security Act Section 1843(a)(11)(B) and its implementing regulation at 42 CFR 410.38. The CMS regulation contains the details for the face-to-face examination, written order prior to delivery and the list of items subject to these requirements.

The information in this document supersedes the material currently contained in the LCDs and related policy articles. Where there are differences between the policies and this article, this document shall take precedence. This information will be added to future revisions of all LCDs and related Policy Articles.

Many errors reported in DME MAC MR Reviews and CERT Audits arise from problems associated with submitted documentation; consequently, the DME MACs have created a standardized language for use in Local Coverage Determinations and related Policy Articles. Standardized language first appeared in 2012 and with subsequent changes in CMS and DME MAC program instructions, is being revised with this publication. The updated language will be inserted in the applicable LCDs and related PAs upcoming revisions to these policies.

The standard sections are written in a modular format to allow each policy to contain information relevant to that policy while omitting material that does not apply. As a result, all modules may not be used in every LCD. This article provides a complete listing of all of the documentation requirement modules. For example, the CMN sections would not be included in the DOCUMENTATION REQUIREMENTS section of an LCD for an item that does not require a CMN.

***IMPORTANT***

Many policies contain coverage and documentation requirements that are unique to that specific policy. Such unique information is not included in this article. It is important that suppliers review the actual LCD to be sure to have all of the relevant information necessary applicable to the item(s) provided.

In several places you will see "placeholders" like "XXX" or "###". Information specific to the policy will be inserted in these spots. Occasionally you may also see "Editor Note" comments. These notes are used to indicate where optional sections may be inserted, when applicable and formatting information.

To read this article in its entirety visit the DME MAC A website at:
http://www.medicarenhic.com/viewdoc.aspx?id=412