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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.
Medicare guidance says "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.). You can find this guidance in the Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 110.2 - Repairs, Maintenance, Replacement, and Delivery, Paragraph C. -Replacement; Medicare Program Integrity Manual, Chapter 3 - Verifying Potential Errors and Taking Corrective Action, Section 3.3.2.1 - Documents on Which to Base a Determination; National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 1 - General Correct Coding Policies, Section A. - Introduction, pages I-7 and I-8 and Chapter 12 - Supplemental Services HCPCS Level II Codes A0000 - V9999, Section A. - Introduction, page XII-3; 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; 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.