Complaint Form for the Durable Medical Equipment - NABP 2025

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Documentation must include the following content: Problem list, including significant illnesses and medical conditions. Medications. Adverse drug reactions. Allergies. Smoking status. Any history of alcohol use or substance abuse. Biographical or personal data. Pertinent history.
Before submitting a claim to the DME MAC, you must have on file a standard written order (SWO), a written order prior to delivery (WOPD) (if applicable), information from the treating practitioner concerning the beneficiarys diagnosis1, and any information required for the use of specific modifiers or attestation
Note: The equipment you buy may be replaced if its lost, stolen, damaged beyond repair, or used for more than the reasonable useful lifetime of the equipment, which is generally 5 years from the date you start using the item. If you rent DME and other devices, Medicare makes monthly payments for the equipment.
As part of the DME documentation requirement, make sure to include the following information, from the physician, with all submitted claims. Benefit and outcome of the patient using the DME items. Clinical and functional status of the patient to show medical necessity. Patients medical record.
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