2024 DMEPOS Series #4: Surgical Dressings

Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements. Medicare Part B suppliers need to be able to produce all the required documentation if audited, and make sure all documentation meets Medicare Part B standards. This DMEPOS series is intended to help you understand these complexities and gather the needed documents.

In particular, you should be able to show the following if audited on surgical dressings:

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  • Standard Written Order (SWO)
    • A new order is required every 3 months for each qualified dressing dispensed, or sooner if the quantity required increases
  • Medical Records must support the surgical dressings are required for one of the following:
    • Treatment of a wound caused by, or treated by, a surgical procedure, or used after debridement of a wound
    • Initial wound evaluation must include:
      • Type, location, number, and size of qualifying wounds (L x W and depth)
      • Amount of drainage
      • Frequency of dressing change
    • Ongoing wound evaluation (weekly or monthly)
    • Specific dressing coverage criteria (in addition to meeting the criteria for qualifying wound)
    • Covered diagnoses can be found in the Local Coverage Determination (LCD) and Policy Article
  • Proof of Delivery
  • Proof of Refill Request and Affirmative Response
    • Required if delivered or mailed

PAAS Tips:

PAAS Audit Assistance members can search the Newsline archive for keyword “DMEPOS series” to read previous articles in this series. If you have any questions on accessing the Member Portal, or need help adding employees so they have access, please contact us at (608) 873-1342 or info@paasnational.com and our staff can assist you.

Jenevra Azzopardi, CPhT
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