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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 all claims for Durable Medical Equipment, Prosthetic, and Orthotic Supplies (DMEPOS) 
require a written order/prescription from the treating practitioner. The supplier must keep the order and proof of 
delivery documentation on file. All services that do not have appropriate proof of delivery will be denied. The 
supplier should also obtain as much documentation from the patients medical record as they determine they 
need to assure themselves that coverage criteria for an item have been met. If the information in the patients 
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 Advance Beneficiary Notice (ABN) of possible denial has 
been obtained. You can find this rule in the Centers for Medicare and Medicaid Services, Internet Only 
Manual, Publication 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2.1, 5.9 and 5.10. 
 
The rules state that suppliers may deliver directly to the beneficiary or the designee. In this case, proof of 
delivery (POD) to a beneficiary must be a signed and dated delivery document. The POD document must 
include: 
1. Beneficiarys name 
2. Delivery address 
3. A description of the item(s) being delivered. The description can be either a narrative description (e.g., 
lightweight wheelchair base), a code, the long description of a code, or a brand name/model number 
4. Quantity delivered 
5. Date delivered 
6. Beneficiary (or designee) signature 
 
The date delivered on the POD must be the date that the DMEPOS item was received by the beneficiary or 
designee. The date of delivery may be entered by the beneficiary, designee, or the supplier. When the suppliers 
delivery documents have both a supplier-entered date and a beneficiary or beneficiarys designee signature date 
on the POD document, the beneficiary (or designee) entered date is the DOS. 
 
If the supplier utilizes a shipping service or mail order, the POD documentation must be a complete record 
tracking the item(s) from the DMEPOS supplier to the beneficiary. An example of acceptable POD would 
include both the suppliers own detailed shipping invoice and the delivery services tracking information. The 
suppliers record must be linked to the delivery service record by some clear method like the delivery services 
package identification number or suppliers invoice number for the package sent to the beneficiary. The POD 
document must include: 
1. Beneficiarys name 
2. Delivery address 
3. Delivery services package identification number, supplier invoice number, or alternative method that 
links the suppliers delivery documents with the delivery services records 
4. A description of the item(s) being delivered. The description can be either a narrative description (e.g., 
lightweight wheelchair base), a code, the long description of a code, or a brand name/model number 
5. Quantity delivered 
6. Date delivered 
7. Evidence of delivery 
 
If a supplier utilizes a shipping service or mail order, suppliers have two options for the DOS to use on the 
claim: 
1. Suppliers may use the shipping date as the DOS. The shipping date is defined as the date the 
delivery/shipping service label is created or the date the item is retrieved by the shipping service for 
delivery. However, such dates should not demonstrate significant variation. 
2. Suppliers may use the date of delivery as the DOS on the claim. 
 
You can find these rules in Local Coverage Article (LCA) Standard Documentation Requirements for All 
Claims Submitted to DME MACs (A55426).  
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.