News

Take Advantage of Enforcement of the Face-to-Face Rule for DME

Date Published: May 15 2015

“Doc fix” bill, HR 2 “The Medicare Access and CHIP Re-authorization Act of 2015” (“MACRA”) was signed into law on April 16, 2015. This “final fix” legislation now permits not only the physician but also a nurse practitioner, physician assistant or clinical nurse specialist to conduct and document a Face-to-Face encounter with a patient during the 6-month period before an Order is written for the DME. MACRA revises the requirement that a physician sign and date those Face-to-Face Notes that a nurse practitioner, physician assistant or clinical nurse specialist generated while conducting the Face-to-Face encounter (as allowed by state law).

Since January 1, 2014, CMS has only been enforcing a portion of the Face-to-Face Rule for DME - that a Face-to-Face encounter take place within the 6 months preceding the date of the Detailed Written Order, and that the supplier secure a compliant Detailed Written Order Prior to Delivery (DWOPD).  The DWOPD must be date stamped by the supplier prior to delivery of any item subject to the rule.

With MACRA clearing the way for nurse practitioners, physician assistants or clinical nurse specialists to conduct and document a Face-to-Face encounter without the additional requirement of a physician signature and date, we expect CMS to promptly begin enforcement of the second portion of the Face-to-Face Rule – the portion that requires suppliers to obtain executed copies of the Face-to-Face Notes from a Face-to--Face encounter performed within 6 months preceding the date on the DWOPD.  The Face-to-Face notes must be signed and dated and then date stamped by the supplier prior to delivery of the DMEPOS item subject to the rule.

Many suppliers are already complying with both portions of this rule, collecting the proper medical necessity documentation from the Face-to-Face encounter before the product is delivered. But many may not be ensuring authentication of the documentation – proper electronic or handwritten signatures (stamped signatures are not acceptable). Expect authentication to be more scrutinized by CMS upon the imminent enforcement of the second portion of the Face-to-Face Rule.  Updated on March 26, 2015, there are currently 164 DME items that are subject to the Face-to-Face rule and many are also currently under pre-payment review in several jurisdictions (CPAP for example). CLICK HERE

Be very careful! Once the second portion of the Face-to-Face Rule is enforced by CMS, if you have delivered your equipment AND billed your claim without compliant documents in hand, Medicare will refuse all future payment to that NPI.  While there are provisions that allow correction of errors identified in the DWOPD and Face-to-Face documentation when identified prior to claim submission, once the claim is submitted the errors are incurable and the beneficiary must seek service through a different provider.

This information is brought to you by Tips From The Trenches. TFTT responds to frequently asked questions from DMEevalumate.com clients. For more information about the face-to-face rule and how DMEevalumate.com can help DME providers obtain compliant and accurate documentation, call 800-986-9368. 

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