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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Per Medicare references listed below the rules state: 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 ZPIC/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." Also, ?Any person who can sign and accept the delivery of durable medical equipment on 
behalf of the beneficiary.? Suppliers, their employees, or anyone else having a financial interest in the delivery 
of the item are prohibited from signing and accepting an item on behalf of a beneficiary (i.e., acting as a 
designee on behalf of the beneficiary). The signature of the designee should be legible. If the signature of the 
designee is not legible, the supplier/shipping service should note the name of the designee on the delivery slip. 
Three methods of delivery are: Supplier delivering directly to the beneficiary or designee; Supplier utilizing a 
delivery/shipping service to deliver items; and Delivery of items to a nursing facility on behalf of the 
beneficiary. ?The date of delivery may be entered by the beneficiary, designee or the supplier. As a general 
Medicare rule, the date of service shall be the date of delivery. Exceptions are made for suppliers who use a 
delivery/shipping service. If the supplier uses a delivery/shipping service, the supplier may use the shipping 
date as the date of service on the claim. The shipping date may be defined as the date the delivery/shipping 
service label is created or the date the item is retrieved for delivery; however, such dates should not 
demonstrate significant variation. (See Pub. 100-08, chapter 5, section 5.2.4 for further information on written 
orders prior to delivery.)? 
 
For any DMEPOS item to be covered by Medicare, the patient?s medical record must contain sufficient 
documentation of the patient?s medical condition to substantiate the necessity for the type and quantity of items 
ordered and for the frequency of use or replacement (if applicable). The information should include the 
patient?s diagnosis and other pertinent information including, but not limited to, duration of the patient?s 
condition, clinical course (worsening or improvement), prognosis, nature and extent of functional limitations, 
other therapeutic interventions and results, past experience with related items, etc. If an item requires a CMN or 
DIF, it is recommended that a copy of the completed CMN or DIF be kept in the patient?s record. However, 
neither a physician?s order nor a CMN nor a DIF nor a supplier prepared statement nor a physician attestation 
by itself provides sufficient documentation of medical necessity, even though it is signed by the treating 
physician or supplier. There must be information in the patient?s medical record that supports the medical 
necessity for the item and substantiates the answers on the CMN (if applicable) or DIF (if applicable) or 
information on a supplier prepared statement or physician attestation (if applicable)?. Also, ?Before submitting 
a claim to the DME MAC the supplier must have on file a dispensing order, the detailed written order, the 
CMN (if applicable), the DIF (if applicable), information from the treating physician 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. 
 
You can find this information in the Medicare References: Medicare Program Integrity Manual, Chapter 5 ? 
Items and Services Having Special DME Review Considerations, Section 5.2.1 - Physician Orders, Section 
5.2.3 ? Detailed Written Orders and Section 5.2.4 ? Written Orders Prior to Delivery, Paragraph A. - General 
and Paragraph C. -Written Orders for Certain Covered Durable Medical Equipment (DME) Items, Medicare 
Program Integrity Manual, Chapter 5 - Items and Services Having Special DME Review Considerations, 
Section 5.7? Documentation in the Patient?s Medical Record and Section 5.8 - Supplier Documentation, 
Medicare Program Integrity Manual Chapter 4 - Program Integrity, Section 4.26.1 - Proof of Delivery and 
Delivery Methods. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.