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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/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that Proof of Delivery (POD) documentation must be available to the Medicare contractor on 
request. All services that do not have appropriate POD from the supplier will be denied and overpayments will 
be requested. Suppliers who consistently fail to provide documentation to support their services may be 
referred to the Office of Inspector General (OIG) or the National Supplier Clearinghouse for investigation 
and/or imposition of sanctions. As a general Medicare rule, the date of service shall be the date of delivery. 
There are three methods of delivery. Regardless of the method of delivery, the contractor must be able to 
determine that the item(s) delivered are the same item(s) submitted for Medicare reimbursement and that the 
item(s) were received by a specific beneficiary: 
 
Delivery directly to the beneficiary or authorized representative 
Delivery via shipping or delivery service 
Delivery of items to a nursing facility on behalf of the beneficiary 
Method 1Direct Delivery to the Beneficiary by the Supplier 
 
Suppliers may deliver directly to the beneficiary or the designee. In this case, POD to a beneficiary must be a 
signed and dated delivery document. The POD document must include: 
 
Beneficiarys name 
Delivery address 
A description of the item(s) being delivered. The description can be either a narrative description (e.g., 
lightweight wheelchair base), a HCPCS code, the long description of a HCPCS code, or a brand name/model 
number Quantity delivered 
Date delivered 
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. 
 
In instances where the supplies are delivered directly by the supplier, the date the beneficiary received the 
DMEPOS supply must be the DOS on the claim. 
 
Method 2Delivery via Shipping or Delivery Service Directly to a Beneficiary  
 
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: 
 
Beneficiarys name 
Delivery address 
Delivery services package identification number, supplier invoice number, or alternative method that links the 
suppliers delivery documents with the delivery services records 
A description of the item(s) being delivered. The description can be either a narrative description (e.g., 
lightweight wheelchair base), a HCPCS code, the long description of a HCPCS code, or a brand name/model 
number 
Quantity delivered 
Date delivered 
Evidence of delivery 
 
You can find this information in Medicare's Local Coverage Article: 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.