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CMS Announces Delay Implementing Face-to-Face Requirement

Enforcement Pushed Back to 10/01/2013

We received word yesterday from the American Association for Homecare that CMS announced a delay in implementing face-to-face rule requirements.  A 3 month (90 day) extension moves the deadline to October 1.  To be specific, the enforcement of this rule is the focus of the delay, and we encourage members to continue preparing for this change and setting up necessary processes to be fully ready. 

OAMES appreciates the diligent efforts of the association’s staff and Regulatory Council volunteers in working with CMS for many months on this issue.  As evidenced at the Medicare Conference this week in Indianapolis, frustration levels were high given the complications that arise for HME suppliers to operationalize these requirements and the open questions that need addressed before providers feel confident with compliance, prescribers are informed and enforcement can begin.

We’ll continue working with AAHomecare to provide more information in the coming weeks and press that CMS and NGS aggressively provide physician/prescriber education to ensure all parties affected by this significant change are properly informed. 

The following list-serve message was sent to providers this morning by the Jurisdiction B DME MAC: 

Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for DME (201306-06)

Due to concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of Durable Medical Equipment (DME), CMS will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on October 1, 2013.

Section 6407 of the ACA established a face-to-face encounter requirement for certain items of DME. The law requires that a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME.

Although many DME suppliers and physicians are aware of and are able to comply with this policy, CMS is concerned that some may need additional time to establish operational protocols necessary to comply with this new law.  As such, CMS expects that during the next several months, suppliers and physicians who order certain DME items will continue to collaborate and establish internal processes to ensure compliance with the face-to-face requirement. CMS expects durable medical equipment suppliers to have fully established such internal processes and have appropriate documentation of required encounters by October 1, 2013. 

CMS will continue to address industry questions concerning the new requirements and will update information on our Medical Review and Education website. CMS and its contractors will also use other communication channels to ensure that the provider community is properly informed of this announcement.

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