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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. 
 
The rules say that providers must report services correctly. Procedures should be reported with the CPT code 
that describes the services performed. You can find this rule in the Medicare National Correct Coding Initiative 
Manual, Chapter I(A). 
 
The rules say that 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 requires 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.) You can find this guidance 
in the Medicare Program Integrity Manual, Chapter 5, 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.