CMS Further Delays DME Face-to-Face Requirement until 2014

On September 9th, the Centers for Medicare and Medicaid Services (“CMS”) announced delaying the requirement for face-to-face encounters for certain durable medical equipment (“DME”).  Originally, CMS intended this requirement to be enforced as of July 1st; however CMS announced delay until October 1st of this year.  Now, CMS explained it “will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning by a date that will be announced in Calendar Year 2014.”

Section 6407 of the Affordable Care Act established that a physician must document that a nurse practitioner, physician assistant, physician or a clinical nurse specialist has had a face-to-face encounter with a patient prior to providing a written order for the DME.  This encounter must occur within the six (6) months prior to such an order.  In light of operational issues, CMS is delaying this requirement until a later specified date in 2014.

Tips for Compliance: What Providers and DME Suppliers Need to Know
  • Providers and DME suppliers should continue to implement internal processes to ensure compliance with this requirement.
  • If a nurse practitioner, physician assistant, or a clinical nurse specialist orders certain DME, a physician must document the face-to-face encounter by signing or co-signing the medical record.
  • At a minimum, DME orders must include the beneficiary’s name, the item of DME ordered, the practitioner’s National Provider Identifier, the signature of the ordering practitioner, and the date of the order.
  • Only certain DME are covered under this requirement.  For a complete list, please see the CMS list here.
If you or your organization has any questions regarding this requirement, or have any questions regarding DME, please feel free to contact Robert A. Wade at (574) 485-2002 or Alex T. Krouse at (574) 485-2003.