One of the most common errors I see when auditing wound care and DME billing is found in box 17 on the CMS 1500 form. This is the box that lists the referring, supervising, or prescribing physician.
Many electronic health record (EHR) programs automatically fill in this information with the referring physician (aka the primary care physician). This is helpful when you are performing at-risk nail care and the patient’s referring physician is their treating physician, but it is detrimental to your practice if you are dispensing DME.
YOU are the prescribing/referring physician for the DME item, not the patient’s primary care physician. When the primary care physician information stays in box 17, you are attesting to the government that the patient’s primary care physician prescribed the DME item when, in fact, you prescribed the item. If you are audited, this can cause problems because your billing states you have a prescription from their primary care physician when in fact you do not. You are the one that prescribed it.
When you applied for your DME license from Medicare you attested that you are only going to dispense DME products for your clinic’s personal patients. You are not allowed to “fulfill” items for other physicians outside of your clinic. If you have the wrong physicians in box 17 it can also cause a denial, because you are fulfilling these items and not prescribing.
If you are unsure where to access Box 17 in your billing software reach out to the EHR manufacturer or use the form below to contact me, and I will be happy to help.
Be smart, and make sure that you are the prescribing physician listed in box 17 on your claim. You will be thankful you did.