Doctors

Your Role:

1. Complete a Face-to-Face Exam
2. Document a face-to-face exam report in the patient’s medical record, send to the involved DME provider
3. Provide a prescription for a specialty therapist evaluation with a diagnosis
4. Once the therapy evaluation has been completed, review and sign the therapist’s evaluation and return it
5. Provide a prescription (7- element order) for the mobility device
6. Review & sign a Detailed Product Description (DPD) provided by the involved DME provider. Return it to that provider

What is included in a 7-element order?

1. Patient Name
2. Date of Completion Face to face Exam(s)
3. Length of Need
4. Item Ordered
5. Pertinent diagnoses/condition related to the need for mobility device
6. Physician Signature
7. Date of Physician Signature

Critical Timeline:

• PROVIDE (7- element order) ONLY AFTER ALL VISITS and EXAMS ARE COMPLETED
• All documents above must be provided to the DME supplier within 45 days of the date of the physician’s signature on the face-to face exam(s)
• The PMD must be delivered within 120 days of the date of the physician’s signature on the COMPLETION OF face-to face exam(s)

Center for Medicare/Medicaid Services (CMS) Required Physician Documentation link:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/PMD_DocCvg_FactSheet_ICN905063.pdf