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Home Health & Hospice Week

Regulations:

Timeline, Exam Limits Add To Burden

Published on Thu Aug 26, 2004

Check out these regulatory specifics that could create a bureaucratic nightmare for you.

If the proposal for a new face-to-face exam for any DMEPOS orders is finalized, suppliers will have to wrestle with a bevy of new requirements.
 
In the 2005 physician fee schedule proposal published in the Aug. 5 Federal Register, the Centers for Medicare & Medicaid Services spells out its tough new plan (see story, p. 235).
 
First, the physician or prescribing practitioner (physician assistant, clinical nurse specialist or nurse practitioner) must:
 

  • conduct a face-to-face examination to determine the medical necessity of each item of durable medical equipment, prosthetics, orthotics and supplies;
     
  • conduct the face-to-face exam for the initial order and at the time of the prescription renewal for items of continued need, such as infusion pumps or hospital beds; and
     
  • be independent from the DME supplier and not the supplier's employee or contractor.

    Then these exacting requirements also must be fulfilled:
     

  • the physician must sign and complete a written order before delivery of any DMEPOS to the beneficiary;
     
  • the physician must sign and date the order within 30 days after the face-to-face exam;
     
  • the beneficiary's medical record must include verification of the face-to-face exam; and
     
  • the physician must document in the medical record the need for the DMEPOS being ordered.

    CMS may also determine additional payment criteria, such as prescription renewal requirements, repairs, minor revisions and replacement, through contractor instructions, it says.
     
    CMS stresses in its regulatory preamble that the physician's patient record must have contemporaneous documentation of the need for the DMEPOS. "For example, a letter to the supplier or to us dated months after the date the examination was conducted and the order was written would not be sufficient verification," the agency warns in the Federal Register notice.
     
    Beware: CMS also throws in this warning: "Medicare does not pay for a face-to-face examination for the sole purpose of the beneficiary's obtaining the physician's or prescribing practitioner's order for the durable medical equipment."
     
    In the preamble, the agency insists that physicians should be treating the patient for the medical condition that necessitates the DMEPOS anyway, so the exam should be for that condition.
     
    And because "in most cases" the physician is already seeing the patient for that condition, requiring this exam before DMEPOS orders shouldn't "place a burden on the physician or beneficiary," CMS judges. DMEPOS suppliers, however, strongly disagree.

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