Medicare has a list of products for which it requires a WOPD - written order prior to delivery.
Medicare takes these products seriously, and providers should too!
In an insightful Medtrade article, the author writes: “Medicare is so serious that there are no do-overs. Submitting a claim with a noncompliant WOPD creates an uncurable error at the PTAN level.”
Here’s what providers NEED to know:
Prior Authorization CAN Be Helpful
Many of the HCPC codes on the WOPD list ALSO require prior authorization. For these items, prior authorization is a natural control. However, not all items on the WOPD list require it, so providers must be sure to look beyond prior authorization.
Some Codes Do NOT Have A Prior Authorization Checkpoint
The Medtrade article states: “The vulnerability is greater for the 38 FTF/WOPD codes that do not require prior authorization because no outside process forces that pre-delivery check.”
Among the codes that do not require prior authorization include hospital beds, oxygen, ventilators, manual wheelchairs, power wheelchairs, orthoses, and bone stimulators.
In these cases, internal controls are crucial to ensure compliance.
What Should Providers Do?
Suppliers should establish at least two checkpoints for the 38 FTF/WOPD codes that do not require prior authorization.
“Before delivery,” the Medtrade author suggests, “the intake or delivery workflow should verify a compliant WOPD is in hand before the product reaches the beneficiary.”
This, of course, is the cleanest, simplest way to ensure the product is WOPD compliant. However, things fall through the cracks. Thus, before claim confirmation and release, the billing team should also verify the WOPD was obtained.
The secondary precaution could mean the difference between correcting an understandable mistake and making an unfixable error.
