Enforcement delay adds time for durable medical equipment requirement

Regulators have given physicians another three months to comply with requirements that they perform face-to-face encounters with patients before prescribing certain durable medical equipment.

The Centers for Medicare & Medicaid Services (CMS) originally planned to begin actively enforcing and expecting compliance with the durable medical equipment (DME) face-to-face requirement on July 1, 2013. But CMS late last month announced it would push the deadline back to Oct. 1, 2013.

The rule in question implements section 6407 of the Affordable Care Act, which requires that a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient within six months before the order is written for certain kinds of DME. The list of DME subject to this requirement included many items that have historically been targets of Medicare fraud as identified by various program integrity experts.

CMS indicated that the delay in enforcement is due to concerns that some physicians and suppliers may need additional time to establish operational protocols necessary to comply with the rule. That means more time for you to work with suppliers from whom you order certain DME items to establish the necessary processes to ensure compliance with the face-to-face requirement. At least that is what CMS expects you to do with the extra time.

Please note that this new requirement does not affect the implementation of the latest round of the DME competitive bidding program. That round began on July 1, 2013, in the designated competitive bidding areas.

CMS will continue to address industry questions concerning the new requirements and will update information on its web site and through the Medicare Learning Network.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians