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Reminder of New DME Face-to-Face Requirements

on Monday, 30 September 2013 in Health Law Alert: Erin E. Busch, Editor

The Centers for Medicare and Medicaid Services (“CMS”) recently announced that enforcement of the face-to-face requirement for providers ordering durable medical equipment (“DME”) will be postponed until 2014. While implementation of the rules has been delayed, providers and suppliers should be familiar with the requirements. The following set of questions and answers provides a good refresher of the scope and implications of the new rules.


What does the law require?

Section 6407 of the Patient Protection and Affordable Care Act requires a physician, physician assistant, nurse practitioner, or clinical nurse specialist to have an in-person or telemedicine meeting with a patient during the six-month period prior to prescribing certain types of DME (listed below). The meeting must be documented in the patient’s medical record and signed/co-signed by a physician.


What types of DME are affected?

Examples of DME covered by the new face-to-face requirements include, but are not limited to: hospital beds and accessories, oxygen, nebulizer compressors, CPAP/BiPAP, seat lift mechanisms, and manual wheelchairs. The rule does not apply to power mobility devices (“PMDs”) and does not supersede other regulations specific to PMDs.


What must the DME order include?

At a minimum, the written DME order must: include the beneficiary’s name, the item of DME ordered, the prescribing practitioner’s NPI, the signature of the prescribing practitioner, and the date of the order. The order for DME cannot be completed before the face-to-face encounter.


What documentation of the face-to-face encounter is required?

In order to receive payment after the face-to-face encounter occurs, all of the following items must be documented in the patient’s medical record: evaluation of the patient, a needs assessment, treatment plan, and relevant diagnosis. The record must clearly establish that the patient was evaluated and/or treated for a condition that supports the item(s) of DME ordered. If a non-physician practitioner conducts the face-to-face examination, a physician must sign or co-sign the patient’s medical record documenting that the encounter occurred.


What are the supplier notification requirements?

Following the encounter, when an order is sent to the DME supplier, the ordering physician must also provide the DME supplier with the medical record and any other supporting documentation. This is required because the DME supplier that submits the claims for the DME items must make this documentation available to CMS upon request.

There is no particular method required for transmitting documentation of the face-to-face encounter. Practitioners and suppliers can communicate the required information through existing business processes.


Is there compensation for face-to-face encounters?

Face-to-face encounters conducted by a physician may be billed using an Evaluation and Management (“E&M”) code. If a non-physician practitioner conducts the encounter and the physician signs/co-signs the order, a billing code G0454 may be used. If a non-physician practitioner orders multiple items of DME the G-code may only be used once.


Do Medicare beneficiaries discharged from the hospital need a separate face-to-face encounter?

No, so long as the physician who performed the face-to-face encounter in the hospital issues the DME order within six months after the patient’s date of discharge from the hospital.


Does this requirement apply retroactively to orders already written?

No. The face-to-face requirement is for new DME orders only.


What are the next steps?

In the upcoming months, health care providers and DME suppliers should establish internal processes to ensure compliance with face-to-face requirements.


Laura A. Feldman

1700 Farnam Street | Suite 1500 | Omaha, NE 68102 | 402.344.0500