News

Providers and Physicians Gravitate to Technology

Date Published: May 20 2015

The plight to obtain accurate documentation from physicians has been burdensome for providers and frequently described as the ping-pong effect. Historically paperwork goes back and forth between the two entities several times before it is complete. The prior authorization demonstration for power mobility devices prompted a sense of urgency for physicians and providers to work together to ensure that medical necessity is accurately identified and documented the first time. “Doc fix” bill, HR 2 “The Medicare Access and CHIP Re-authorization Act of 2015” (“MACRA”) that was signed into law on April 16, 2015, 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.

With MACRA clearing the way for NPs, PAs or CNs 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.

The 69% decrease in beneficiaries receiving a power mobility device between September 2012 and June 2014 is not insignificant. Peggy Walker explained in a HME News article "mistakes vs. fraud" that few providers in the DME industry intentionally bill for items they did not provide, or are providing items that that are not truly medically necessary. However, fraudulent providers do exist and while they are the exception, they have not helped portray a trustworthy and reputable image of DME providers. Trust has been one of the biggest hurdles providers have had to overcome when attempting to educate physicians about Medicare's coverage criteria for DME. That, and the fact that the best documentation solutions are standardized online tools that require the physician to try something new. We can't blame them for not wanting to add one more thing to their plate and many physicians are choosing not to prescribe PMDs as a result. It is believed that the 69% decline in PMDs in the seven original PA Demo states is largely a result of this. We believe the wheel is turning. There are now viable tools for physicians to utilize that take the uncertainty out of face-to-face documentation.

Standardized online documentation tools such as DMEevalumate.com have bridged the gap between physicians and providers. These tools provide all parties with the opportunity to play by the rules and work together to help the patients get and keep equipment they qualify for. Our programmers are committed to building the algorithms that incorporate the coverage criteria and take the guess work out of the face-to-face documentation requirements. In 2015 we will see even more providers and physicians gravitating toward solutions that meet the stiffer documentation scrutiny. 

This year, we have a team going to provider locations all around the nation to see firsthand how they are succeeding in obtaining accurate documentation from their referral sources. Check our Twitter account @DMEevalumate to learn what others are doing. 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 to view a complete list of specified items. 

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