To place an order on behalf of a patient that is being used to bill any insurance we will need the following 7 requirements to be met. Medicare refers to this as “Detailed Written Order”, or DWO for short and those requirements are: 

• Patient Name
• Start Date (usually the day the order is written) 
• Specific type of equipment (see our “easy order form” for specific equipment verbiage
• Prescribing Dr. Name (printed)
• Date Signed
• Prescribing Dr. Signature 
• NPI number

*If your office or hospital does not have it’s own ERM for electronically sending prescriptions, please consider using Mayhugh’s Easy Order form to fulfill all these requirements in a single document. If you don’t see the type of equipment you’re trying to order feel free to write it in anywhere on the document. 

Along with those 7 elements we also require: 

• Patient Demographics 
• Patient’s Height & Weight
• Insurance information 
• Office notes from most recent visit

These 4 items DWO, Demos, Insurance info and Office Notes are sufficient for most orders of standard medical equipment (Walkers, Rollators, Wheelchairs, Hospital beds, Commodes etc.) 

For 24 hour (continuous) and Portable Oxygen: 

• ’6 minute walk’ test 

Or 

• ’At Rest On Room Air’ test 

*These tests must show an SPO2 desaturation of 88% or lower without supplemental oxygen (on room air) and then an oxygen titration showing the level of oxygen required to bring the patient back to ‘normal’ SPO2 levels. 

*If your facility does not conduct these tests, you can order them to be performed at the patient’s home by our partner testing company. 

If your patient does not desaturate with either of these tests and you’re still considering oxygen therapy, they may qualify for Nocturnal Oxygen therapy with an overnight oximetry test. This test can be easily performed in the patient’s home using a simple bracelet device. This self administered test is delivered by us to the patient and picked up the next day after testing is complete. The results of the test are automatically transmitted wirelessly by the device at which time the order can be written. 

To order an overnight oximetry test, simply send us an order and using our Easy Order Form or your own EMR ordering system. 

For CPAP Equipment and Supplies (New Customers):

• DWO listing the specific type of equipment (ie Nasal Mask, Cushions, Tubing, Headgear & Filters or Try our CPAP Order form for specific verbiage)
• Patient Demographics 
• Insurance info
• Sleep Study (performed within the last year)
• Office notes dated prior to sleep study where cpap therapy is mentioned 

For Bi-Level (BiPAP) therapy: 

• A sleep study showing the patient failed using cpap therapy
• A lab-based BiPAP titration with recommended settings (cannot be a home study) 

Or 

For Trilogy Ventilators:  

• DWO listing the specific settings or stated “titrate to patient’s height and weight” (Use our Trilogy Order form for specific verbiage, or our Pre-Filled Trilogy order form with the most commonly used settings) 
• Patient Demographics 
• Patient’s Height & Weight
• Insurance info
• History of respiratory failure 
• An arterial blood gas (ABG) showing a CO2 level of 55 mmHg or greater 
• Notes stating “BIPAP therapy was considered and deemed inappropriate” 

For Power Wheelchairs and Scooters : 

• DWO listing the specific type of equipment being ordered
• Patient Demographics 
• Patient’s Height & Weight
• Insurance info
• PT or OT Evaluation  (can be done in the office but requires specific language, refer to our “Power Mobility Notes pdf for specific verbiage)
• Home Evaluation (Performed by Mayhugh’s, this evaluation of the patient’s home is required to be sure the equipment can fit through doorways and allow patient to perform basic tasks such as getting to the restroom, getting to the kitchen, and getting to bed)

*If you plan to refer out the PT/OT eval to another healthcare provider we recommend sending your power mobility orders after the PT/OT eval is completed. The reason for this is once the order for power mobility is written there is a deadline of 30 days to fulfill the order (delivery of equipment) before the process needs to start all over again.

Nearly all of our equipment is covered by insurance with a few exceptions. Some of these exceptions have to do with specific diagnosis restrictions (i.e. oxygen therapy orders with a diagnosis of pleural effusion are only covered when written from a medical office due to most insurance requirement that the patient be in a “chronic-stable state, with no underlying conditions”), other restrictions have to do with insurance company’s determination of “Medical Necessity”. 

A good thing to remember when writing an order that will be covered by your patient’s insurance is: “is there a cheaper option that has a similar therapeutic effect” if yes, that will likely be the option that is covered by the patient’s insurance. 

Here’s a short list of common items that are usually NOT COVERED by any insurance: 

• Bathroom items including: Toilet Seat Risers, Bath or Shower Chairs, Grab Bars, Walk-in Tubs
• TV Trays 
• Lift Chairs (except the lift mechanism, usually about ⅓ of total cost) 
• Knee Scooters (aka Knee Walkers) except by certain insurances
• Certain Braces
• CPAP Cleaners (Devices and Wipes)
• Travel CPAP Machines

Or any equipment ordered without a qualifying diagnosis or lacking necessary paperwork.

Apart from this, coverage is always determined by benefits outlined in the patient’s plan and any deductibles or copays required by the insurer. 

Navigating the complex world of insurance coverage can be frustrating and complex. The good news is, Mayhugh’s is here to help. Send us the order and our billing experts will determine if the item is covered and if any supplementary documentation is needed.