Current through Register 1531, September 27, 2024
(A)
Proof of Delivery. Orthotics providers must maintain
proof of delivery (POD) in the member's medical record. POD documentation must
be made available to the MassHealth agency upon request. Orthotic providers may
use one of three methods to deliver orthotics to the member: direct delivery;
delivery via shipping; or delivery in anticipation of hospital
discharge. The orthotics provider, in conjunction with the member or their
designee, will determine the method of delivery.
(B)
Timelines of
Delivery. The orthotics provider must ensure that orthotics are
delivered within a reasonable time after receipt of the detailed written order
and any required documentation or approval for the item. This includes
referring the member to another orthotics provider, when timely delivery cannot
be made by the current orthotics provider. The MassHealth agency, or its
designee, reserves the right to issue additional subregulatory guidance on
reasonableness of delivery times for customized orthotics and specific orthotic
items.
(C)
Direct
Delivery. The orthotics provider may deliver the orthotic product
directly to the member or dispense the product to the member at the provider's
service location. In this case the POD must be a signed and dated delivery
slip. The POD documentation must include:
(1)
member's name;
(2) sufficiently
detailed description to identify the item(s) being delivered (such as, brand
name, HCPCS code, narrative description);
(3) quantity delivered;
(4) date delivered; and
(5) member (or member's designee) signature
and date of signature. The date of signature on the delivery slip must be the
date that the orthotic product was received by the member or member's
designee.
(6) In instances of
direct delivery, for purposes of filing a claim for payment, the date of
service on the claim must be the date the member received the orthotics, as
evidenced by the date of the member's (or member's designee) signature on the
delivery slip.
(D)
Delivery via Shipping Service.
(1) Providers of orthotics may use a shipping
service to deliver orthotic products;
(2) If the provider of orthotics utilizes a
shipping service, the POD documentation must include a complete tracking
record. An example of acceptable POD would include both the provider's own
detailed shipping invoice and the shipping service's tracking information.
Providers may also utilize a return postage-paid signed shipping invoice from
the member or the member's designee as evidence of POD. The POD record must
include:
(a) member's name;
(b) delivery address;
(c) shipping service's package identification
number, provider of orthotics' invoice number or alternative method that links
the provider of orthotics' delivery documents with the shipping service's
records;
(d) sufficiently detailed
description to identify the item(s) being delivered (e.g.,
brand name, serial number, narrative description);
(e) quantity delivered;
(f) date delivered; and
(g) evidence of delivery.
(3) If a provider of orthotics
utilizes a shipping service, for purposes of filing a claim for payment, the
date of service is the date the orthotics was shipped to the member.
(E)
Delivery to
Members in a Facility. Delivery to members in facilities and to
members being discharged from facilities to a community dwelling;
(1) Delivery of orthotics products to a
nursing facility or ICF/IID on behalf of a member:
(a) Providers of orthotics may deliver
orthotics for a member directly to a nursing facility or ICF/IID. When the
provider of orthotics delivers items directly to a nursing facility or ICF/IID,
the documentation described in 130 CMR 442.424(C) is required. When a shipping
service is used to deliver the item to a nursing facility or ICF/IID, the
documentation described in 130 CMR 442.424(D) is required.
(b) The date of service on the claim must be
the date as specified in 130 CMR 442.424(C)(2) or 130 CMR 442.424(D)(2), as
applicable.
(2) Delivery
in anticipation of discharge from a hospital:
(a) A provider of orthotics may deliver an
orthotic product to a patient in a hospital for the purpose of fitting or
training the patient in the proper use of the item. This may be done up to two
days prior to the patient's anticipated discharge.
(b) The date of service for purposes of
filing a claim for payment is the date of discharge with the member's home as
the place of service (POS).
(c) The
provider of orthotics may not bill MassHealth for days prior to discharge, such
as days the patient was receiving training or fitting in the
hospital.
