HNS Policy 

For all DME provided and billed through HNS, medical necessity for the services must be clearly documented in the patient's health care record and must be consistent with the patient's chief complaint/clinical findings, diagnoses, and treatment plan. 

All DME provided and billed through HNS must be consistent with all HNS and HNS contracted payor policies, the policies of applicable state licensing boards as well as state and federal laws.

All DME services provided must be documented in the health care record. 

DME services are reported using HCPCS codes.  HNS providers must accurately report the correct HCPCS code on all insurance claims filed through HNS.

Documentation in the health care record must include the specific DME recommended, the date the DME was ordered, and the date the DME was delivered to the patient. Proof of purchase of the DME, unless rented, must be available upon request if requested by a contracted payor or HNS.  Rental agreements for DME must be available upon request if requested by a contracted payor or HNS.

Documentation in the health care record should include all instructions given to the patient regarding the use of any DME.  If written standards are maintained for DME that include specific instructions, reference to the written standard is acceptable.

If written standards for DME are utilized, they should include the following statements:

• The patient’s health care record clearly establishes the medical necessity for any DME billed to the payor.

   

• The need for any DME billed to a payor is consistent with the patient’s chief complaint/ clinical findings, diagnoses, treatment plan, and payor policies.