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Tip From The Trenches

Date Published: June 14 2013

Which DME items require a face-to-face evaluation and detailed written order from a physician?

Effective July 1 2013, Medicare requires a face-to-face evaluation for most DME equipment.

 

This new requirement is for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for more than a hundred DME items, as identified by the Centers for Medicare & Medicaid Services (CMS).

 

As a condition for payment, Section 6407 of the Affordable Care Act requires a physician to document a face-to-face evaluation with a patient in the six months prior to the written order for DME items, including a variety of mattress pads, hospital beds, portable oxygen systems, and lift mechanisms to name but a few. To view a complete list of items under this new rule, click CMS MLN Matters Released May 31, 2013.

 

This change means that a patient can no longer simply call their primary care physician and request the DME items identified in this new rule and receive a prescription. Instead, they will need to schedule an appointment for a face-to-face evaluation. The date of the face-to-face evaluation must be prior to the date of the written order.

 

The face-to-face encounter conducted by the physician, PA, NP or CNS, must document that the beneficiary was evaluated and/or treated for a condition that supports the item(s) of the DME ordered. If completed by a PA, NP or CNS, the physician must co-sign and date the pertinent portion of the medical record.

 

The written order for the DME item must include the following:

1/ The beneficiary’s name

2/ The DME item

3/ The prescribing practitioner’s National Provider Identifier (NPI)

4/ Practitioner’s signature

5/ The date of the order

 

DME providers should not vend any of the DME items listed in this new requirement without a detailed written order and the office visit note, otherwise known as a face-to-face evaluation, and expect Medicare coverage for the vended equipment. Failure to obtain the required paperwork will result in the denial of the claim, when reviewed in a pre-or post-payment audit.

For more detailed information about the new face-to-face rule for DME items, go to www.CMS.gov and search Medicare Learning Network (MLN) Matters, number MM8304.

This information is brought to you by DMEevalumate.com Tips from the Trenches, in response to FAQs from our customers. For more information, contact us at info@DMEevalumate.com 

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