Moving the HME Industry Forward

Legislative/Advocacy

CMS Postpones Start of Face-to-Face Requirement

July 1, 2013

WASHINGTON, DC – Citing the suppliers’ need for “additional time to establish protocols for newly required face-to-face encounters,” CMS postponed the start of face-to-face requirements until October 1, 2013. At that time, CMS will expect full compliance.

Prior to the delay, industry advocates such as Lisa M. Getson, executive vice president, Government Relations and Corporate Compliance, Apria, predicted that the DMEPOS error rate would skyrocket if providers were not given more time. “And the industry would again be painted with a broad brush of non-compliance or ignorance,” warned Getson two weeks ago.

CMS expects that during the next several months, suppliers and physicians who order certain DME items will continue to collaborate and establish internal processes to ensure compliance with the face-to-face requirement. CMS expects DME suppliers to have fully established such internal processes and have appropriate documentation of required encounters by October 1, 2013.

AAHomecare has informed CMS of its concerns regarding the lack of information on this new requirement. To address this issue, the AAHomecare Regulatory Council has drafted a questions and answers document that will help providers deal with real-world situations. This document was sent to CMS, and the Agency’s legal counsel is now reviewing it.

AAHomecare’s Background Information Regarding Face-to-Face Requirement
The CMS final rule for the 2013 physician payment policies revisions, issued on November 1, 2012, included a policy to require, as a condition of payment for certain DME, that a physician, physician assistant, nurse practitioner, or clinical nurse specialist has had a face-to-face encounter with the beneficiary. This encounter must be documented by the physician and communicated to the DME provider. The face-to-face encounter must occur within six months before the written order.

The DME face-to-face encounter requirement applies to written orders on or after July 1, 2013. The requirement applies to new DME orders only.

The rule specifies the following four criteria that would subject covered items to the face-to-face requirements:
1) items that currently require a written order prior to delivery per instructions in CMS’ Program Integrity Manual;
2) items that cost more than $1,000 (according to the fee schedule price ceiling);
3) items that CMS, based on experience and recommendations from the DME MACs, believes are particularly susceptible to fraud, waste, and abuse; and
4) items determined by CMS as vulnerable to fraud, waste, and abuse based on reports of the HHS Office of Inspector General, Government Accountability Office, or other oversight entities.