CMS has pushed back indefinitely enforcement of an Affordable Care Act (ACA) provision requiring a face-to-face encounter as a condition of Medicare payment for certain durable medical equipment (DME) items.
By way of background, under CMS rules implementing section 6407 of the ACA, 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 within the six month period before the written order. The initial items subject to this rule include: items that require a written order prior to delivery under the Medicare Program Integrity Manual; items that cost more than $1,000; and items identified as particularly susceptible to fraud, waste, and abuse.
While CMS had previously set implementation dates of July 1, 2013 and then October 1, 2013, CMS is now delaying enforcement of the DME face-to-face requirement until “a date that will be announced in Calendar Year 2014." CMS explains that this delay will enable suppliers and physicians to collaborate and establish internal processes to ensure compliance with the face-to-face requirement over the next several months, but it also notes states that “suppliers and physicians who are currently implementing the face-to-face requirement should continue to do so.”