CMS made some big announcements this week for the DME industry. Most notable is the delay in enforcement of the Face-to-Face (FTF) regulations set forth in the Affordable Care Act. Originally set to go into effect for new orders on or after July 1st, the enforcement of these regulations is now delayed until October 1, 2013. FTF affects a total of 166 HCPCS and requires that a physician (with an MD or DO credentials) document the face-to-face encounter with the beneficiary and sign off on evaluations performed by nurse practitioners, physician assistants or clinical nurse specialists. The evaluation of the beneficiary must have taken place within the six months prior to the detailed written order. Additional requirements handed down for those 166 codes disqualify the use of verbal orders to dispense equipment and instead subject these HCPCS to the detailed written order prior to delivery (WOPD) requirements.
Official education on these requirements has been scarce until recently when CMS issued MLN Matters article 8304 which speaks directly to the necessity of documenting the FTF encounter, but did not speak to the requirement of the WOPD in its original release (it was later updated to clarify those requirements). CMS cites the concern that some providers are unprepared for implementation and will need additional time to implement the proper protocols for compliance. However, in our opinion, lack of sufficient education on the entirety of the rule for suppliers and physician referral sources is the most compelling reason for the delay.
Official education on these requirements has been scarce until recently when CMS issued MLN Matters article 8304 which speaks directly to the necessity of documenting the FTF encounter, but did not speak to the requirement of the WOPD in its original release (it was later updated to clarify those requirements). CMS cites the concern that some providers are unprepared for implementation and will need additional time to implement the proper protocols for compliance. However, in our opinion, lack of sufficient education on the entirety of the rule for suppliers and physician referral sources is the most compelling reason for the delay.
It is important for providers to understand that the program itself is not delayed; Face-to-Face regulations will still exist starting July 1st. It is the enforcement of those regulations that is to be delayed until October 1st. For providers, this means that auditing contractors will not deny claims for compliance with FTF requirements when identifying overpayments for new orders prior to October 1st, 2013. Providers that are already in compliance with the FTF rule should continue that protocol. Those who have not yet established procedures should work diligently to become compliant by the deadline of October 1st. CMS will expect full compliance of all providers by the October 1st deadline.
CMS has indicated that it will continue to update information concerning the face-to-face rule via their website at www.cms.gov/medical-review MiraVista will keep you informed as updates are released. More detailed coverage of the Face-to-Face ruling can be found in our signature Vista Notes publication or in select digital recordings (specifically “New Face-to-Face Requirements Get Finalized for DME: Are you Ready for Implementation” recorded on 02/07/2013) that can be found on our products page.
CMS has indicated that it will continue to update information concerning the face-to-face rule via their website at www.cms.gov/medical-review MiraVista will keep you informed as updates are released. More detailed coverage of the Face-to-Face ruling can be found in our signature Vista Notes publication or in select digital recordings (specifically “New Face-to-Face Requirements Get Finalized for DME: Are you Ready for Implementation” recorded on 02/07/2013) that can be found on our products page.
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