Face-to-Face Encounter home page on December 3rd, 2013, has sent providers reeling. The clarification states “The delay of enforcement only applies to the face-to-face requirements in CFR §410.38(g)(3). CMS expects full compliance with the remaining portions of the regulation.” Earlier this year the final rule mandating Face-to-Face Encounters for select items of DME, affecting 166 HCPCS, indicated an effective date of July 1, 2013. However, CMS issued a delay to October 1, 2013, and then further delayed enforcement until a date yet to be announced in 2014. This rule not only requires that a face-to-face encounter with a physician, nurse practitioner, physician’s assistant or clinical nurse specialist take place and be documented within six months prior to the detailed written order, but an additional requirement also establishes the necessity to collect a Detailed Written Order prior to delivery (even in cases where a verbal or dispensing order had previously been sufficient).
CMS begun instructing contractors to educate providers on a few key expectations, notably that they are expecting DME providers to follow all of the written order prior to delivery requirements set forth in the rule (dating back to July 1, 2013).
CMS begun instructing contractors to educate providers on a few key expectations, notably that they are expecting DME providers to follow all of the written order prior to delivery requirements set forth in the rule (dating back to July 1, 2013).
We have discovered that behind the scenes, the Program Integrity Manual has already been updated in several key sections through Revision 468. This revision cites it was: Issued: 05-31-13; was Effective 07-01-13; and has an Implementation of 07-01-13. The Program Integrity Manual (PIM) is the instruction manual used by the auditing contractors to enforce Medicare policy. These citations clearly state they are in effect and implemented as of July 1, 2013 which is quite troubling from a retroactive audit standpoint. The following are brand new sections that detail CMS expectations about procurement of a written order prior to delivery for items subject to the face-to-face rule: Section 5.2.3.2 Detailed Written Orders for Face-to-Face Encounter, 5.2.3.2.1 – Face-to-Face Encounter Conducted by the Physician, 5.2.3.2.2 – Face-to-Face Encounter Conducted by a Nurse Practitioner, and 5.2.3.2.3 – Detailed Written Order for Covered Items.
Another curveball popping up in education sessions from some of the DME MACs includes instructions that they expect providers to have signed medical record notes in hand before delivering equipment to comply with the rule (after the delay expires). If CMS maintains this course, this interpretation will be particularly burdensome to physician practices that send all their documentation out for transcription prior to making the documents available. The interpretation is also counter intuitive to several critical need products such as oxygen and other items on the list.
Providers and advocate agencies have been reaching out to specifically discuss the impossibility of a retroactive enforcement of these additional provisions due to the inextricable connected nature to the Face-to-Face provisions. The industry has been told that a Med Learn Matters article is forthcoming, but we are hopeful we can come to a mutual understanding of the key issues prior to the release of formal education on these issues. Uncertainty still remains regarding several key issues, however, as more information on this topic develops, MiraVista will continue to disseminate key updates. Please see additional education on this topic on our blog and via our Products menu.
Another curveball popping up in education sessions from some of the DME MACs includes instructions that they expect providers to have signed medical record notes in hand before delivering equipment to comply with the rule (after the delay expires). If CMS maintains this course, this interpretation will be particularly burdensome to physician practices that send all their documentation out for transcription prior to making the documents available. The interpretation is also counter intuitive to several critical need products such as oxygen and other items on the list.
Providers and advocate agencies have been reaching out to specifically discuss the impossibility of a retroactive enforcement of these additional provisions due to the inextricable connected nature to the Face-to-Face provisions. The industry has been told that a Med Learn Matters article is forthcoming, but we are hopeful we can come to a mutual understanding of the key issues prior to the release of formal education on these issues. Uncertainty still remains regarding several key issues, however, as more information on this topic develops, MiraVista will continue to disseminate key updates. Please see additional education on this topic on our blog and via our Products menu.
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