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Medicare delays face-to-face rule for ordering DME

NEWS IN BRIEF — Posted July 22, 2013

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The enforcement date of a Medicare rule requiring documentation of a face-to-face patient visit with a physician or health professional when ordering certain medical equipment has been postponed until Oct. 1.

The Centers for Medicare & Medicaid Services had been ready to enforce the requirement starting July 1, but concerns regarding operational protocols from physicians and equipment suppliers led the agency to delay the move. The Affordable Care Act mandated in-person encounters within six months of an order for durable medical equipment, such as wheelchairs and oxygen supplies. Once enforcement begins, CMS will not pay the supplier without documentation of a clinical visit.

“Although many durable medical equipment 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,” the Medicare agency stated on its website. “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.”

The rule is one of several anti-fraud provisions included in the 2010 health system reform law. The measure aims to stop payment for unnecessary medical equipment by ensuring it was ordered by physicians or other medical professionals.

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