CMS Announces Additional Time to Establish Face-to-Face Protocols for DME

CMS has advised Congress of the following change to the Face-to-face rule set to go into effect on July 1st

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 for certain items of DME, the Centers for Medicare & Medicaid Services (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 Affordable Care Act 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 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. 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 web site at: www.cms.gov/medical-review

CMS and its contractors will also use other communication channels to ensure that the provider community is properly informed of this announcement.

We note that this new requirement does not affect the implementation of Round 2 of the DME competitive bidding program which is set to start on July 1, 2013 in the Round 2 competitive bidding areas.

This means that the Face-to-Face rule will technically, as a matter of law, go into effect on Monday July 1st 2013. However, because protocols have yet to be developed, they will NOT enforce the rule until October 1, 2013.

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