CMS has just announced that it is delaying enforcement of an Affordable Care Act provision requiring a face-to-face encounter as a condition of Medicare payment for certain durable medical equipment (DME) items from July 1, 2013 to October 1, 2013. Under the regulations implementing the face-to-face requirement, 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 within the six month period before the written order as a condition of payment for specified items of DME. The initial items subject to this provision include: 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 provides a current list of the applicable items here.
CMS is pushing back the compliance date in light of “concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply” with the ACA requirement. CMS expects suppliers and physicians who order specified DME items will use these extra months to collaborate and establish internal compliance processes. CMS and its contractors also will communicate with the provider community to ensure it is informed about the policy. CMS intends to “start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on October 1, 2013.”