As part of CMS’s proposed Medicare physician fee schedule rule, CMS is proposing to implement an ACA provision requiring a face-to-face encounter as a condition of Medicare payment for certain DME items. Specifically, CMS is proposing to expand the written order requirements to provide that, as a condition of payment for specified items of DME, a physician must have documented and communicated to the DME supplier that the physician or a physician assistant, a nurse practitioner, or a clinical nurse specialist has had a face-to-face encounter with the beneficiary no more than 90 days before or within 30 days after the order is written. The encounter must be documented in accordance with specific CMS requirements, and the supplier must retain the written order and supporting documentation for seven years after the date of service. CMS will allow face-to-face encounters to be accomplished via a telehealth encounter if all other Medicare telehealth regulatory requirements are met. CMS proposes a list of specified covered DME items that initially would be subject to this provision, which includes: items that currently require a written order prior to delivery under the Medicare Program Integrity Manual; items that cost more than $1,000; and items been identified as particularly susceptible to fraud, waste, and abuse. CMS states its intention to apply the requirements to prosthetics and orthotics in a future rulemaking. CMS also is proposing the use of a G-code, with an estimated rate of $15, to compensate a physician who documents a face-to-face encounter for the specified DME items. CMS will accept comments on the proposed rule until September 4, 2012.
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CMS proposes face-to-face encounter requirement for Medicare DME orders
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