However, coverage of specific procedures and equipment is determined by the patient's individual policy. You may want to verify insurance coverage prior to performing a procedure or dispensing a DME product. Some procedures may require a completion of a waiver, or, for Medicare purposes, an Advance Beneficiary Notice (ABN), which notifes the patient that the procedure or product may not be covered. Patients should be informed whenever it is likely that an insurer may deny benefits. With a waiver or ABN, the provider may have recourse in the event of non-coverage by an insurer.
Empi's Role as a Supplier
Empi works with referring physicians to ensure full compliance so that patients may receive full benefit of from our product(s) when medically necessary. Empi will file the claim on behalf of the patient. You may contact a Patient Care Service Representative (PCS) at (800)328-2536.
Requirements of the Prescribing Physician
The written order should be transcribed on the physician's personalized pad. In addition to forwarding the written order to Empi, it is recommended that you maintain a copy of the document in your patient's file. The written order should contain the following:
- Patient's Name
- Description of the Item (TENS, NMES, PFS, etc.)
- Physician's Original Signature (no signature or date stamps)
- Date the Physician Signed the Prescription
- Diagnosis information
Additional documentation (i.e. Letter of Medical Necessity (LOMN) or CMN) may be required by the payor to substantiate medical necessity. Empi will contact the physician directly to obtain any necessary information.
Requirements of the Medical Professional
A copy of the patient's medical record(s) and/or progress notes should be available upon request. As a supplier, Empi may be required to submit such documentation at the request of the payor. Please retain a copy of the prescription in the patient's file.
Some payors may require that an Advance Beneficiary Notice (ABN) be signed by the patient prior to the dispense of product or the provision of a service. Providers are required to inform beneficiaries whenever it is likely that a payor may deny benefits. With an ABN, you may be able to protect yourself in the event of non-coverage. Medicare information regarding the ABN is available from the following link: http://cms.hhs.gov/medlearn/refabn.asp