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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 PROOF OF DELIVERY (POD) 
 
42 CFR 424.57(c)(12) requires suppliers to maintain POD documentation in their files. 
 
POD documentation, as well as claims documentation, must be maintained in the suppliers files for 7 years 
(starting from the DOS). 
 
No billing may be made for any DMEPOS to the DME MAC prior to the date of discharge from an inpatient 
facility. A supplier may deliver a DME, prosthetics, or orthotics item (but not supplies) to a beneficiary in an 
inpatient facility that does not qualify as the beneficiarys home, for the purpose of fitting or training the 
beneficiary in the proper use of the item. This delivery may be done up to two (2) days prior to the 
beneficiarys anticipated discharge to their home. The supplier must bill the date of service on the claim as the 
date of discharge and the supplier must ensure that the beneficiary takes the item home, or the supplier picks up 
the item at the facility and delivers it to the beneficiarys home on the date of discharge. Any attempt by the 
supplier and/or facility to substitute an item that is payable to the supplier for an item that, under statute, should 
be provided by the facility, may be considered fraudulent. 
 
Suppliers, their employees, or anyone else having a financial interest in the delivery of the item(s) 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 relationship of the designee to the beneficiary should be noted on the delivery slip 
obtained by the supplier (i.e., spouse, neighbor). 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. 
 
For the purpose of the delivery methods noted below, designee is defined as any person who can sign and 
accept the delivery of DMEPOS on behalf of the beneficiary. 
 
The supplier should also have on file any documentation containing a description of the item delivered to the 
beneficiary to determine the accuracy of claims coding including, but not limited to, a voucher, invoice or 
statement in the supplier records. A description of the items(s) delivered must be noted on the POD. 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. 
 
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.