CMS Issues DME Face-to-Face Encounter Final Rule, Asks for Comments

Editor’s Note:  The 1,362 page advance copy of the CMS Final Rule with comment period, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013” is attached here.  CMS notes that they waived the proposed rule stage of the rulemaking.

With respect to DME, the rule states that it “implements provisions of the Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment (DME) items.”

There is a 60 day comment period and the rule takes effect on January 1, 2013 except for the DME portion which takes effect on July 1, 2013.

With respect to the Information Collection Request (UCR) provisions that relate to DME, the rule states:

As a condition of payment for certain covered items of DME, §410.38(g) specifies that a physician must have documented and communicated to the DME supplier that the physician or physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) has had a face-to-face encounter with the beneficiary no more than 6 months before the order is written.

In the proposed rule, we proposed that when the face-to-face encounter is performed by a physician, the submission of the pertinent portion(s) of the beneficiary’s medical record (portions containing sufficient information to document that the face-to-face encounter meets our requirements) would be considered sufficient and valid documentation of the face-to-face encounter when submitted to the supplier and made available to CMS or its agents upon request.

While we believe that many of the practitioners addressed in this final rule with comment period are already conducting a needs assessment and evaluating or treating the beneficiary for conditions relevant to the covered item of DME, this final rule with comment period may require some changes in their procedures to ensure that their documentation fulfills Medicare’s regulatory requirements. Suppliers should already be receiving written orders and documentation to support the appropriateness of certain items of DME.

To promote the authenticity and comprehensiveness of the written order and as part of our efforts to reduce the risk of waste, fraud, and abuse, as a condition of payment, a written order must include the following: (1) the beneficiaries’ name; (2) the item of DME ordered; (3) the signature of the prescribing practitioner; (4) the prescribing practitioner NPI; and (5) the date of the order.

There is a 60 day comment period on the Paperwork Reduction Act provisions of the rule.