Where is it in writing that I have to have progress notes or documentation in addition to the Certifying Statement of Physician to support medical necessity?
A6: Refer to LCD L1535 Therapeutic Shoes for Person with Diabetes and LCD L11527 AFO, Ankle Gauntlet, which both contain the following. Section 1833(e) of the Social Security Act precludes payment to any provider of services unless “there has been furnished such information as may be necessary in order to determine the amounts due such provider” (42 U.S.C. 1395l (e)). It is expected that the patient’s medical records will reflect the need for the care provided. The patient’s medical records include the physician’s office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation must be available to the DMERC upon request. Region B Supplier Manual Chapter 17, Page 9 of 11 Region A Supplier Manuel Chapter 9 Documentation in the Patient Medical Records For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient documentation of the patient’s medical c
