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Medicare Compliance & Reimbursement

Home Health:

Suppliers Gain Allies In Fight Against Exam Rule

Published on Fri Sep 17, 2004

Docs are on suppliers' side when it comes to fighting new red tape.

There is hope that the new face-to-face exam requirement may be scrapped, or at least significantly scaled back, now that influential physicians are weighing in on the proposal.

The Centers for Medicare & Medicaid Services wants to require physicians to see patients face-to-face when prescribing all items of durable medical equipment, prosthetics, orthotics and supplies. And physicians are hopping mad about the requirement, which the agency proposed in the 2005 physician fee schedule.

What docs are saying: The Aug. 30 meeting of the Practicing Physicians Advisory Committee erupted in a "huge discussion over whether this was overkill because they had one outlandish incident with power wheelchairs," according to Constance Row, executive director of the American Academy of Home Care Physicians. Doctors protested that they already have arrangements in place to keep track of homebound patients' needs, involving home care nurses and nurse practitioners.

"Certainly from the standpoint of the Academy, there is no way this is justified," Row adds.

This proposal is "an incredible waste of time," insists M. Tray Dunaway, a general surgeon in Camden, SC. "The idea behind home health is to save some of my time, so if I'm going to put in a home health consult, I expect a professional to assess the patient's need," grouses Dunaway. "I don't feel compelled to be checking behind them to see if their assessment's correct."

Doctors "often are using home health nurses ... to see [patients] because there just aren't enough doctors to go around," Row agrees. Instituting the face-to-face exam requirement for DMEPOS cancels out that benefit.

Many patients requiring DMEPOS have tremendous difficulty leaving their homes, so forcing them to make a special trip to the doctor just to obtain equipment will be a real hardship, adds attorney Carol Loepere with Reed Smith in Washington. Most doctors are familiar enough with their patients to know when they're likely to need new equipment, she adds.

The exam requirement creates "a very difficult position for the DME suppliers and the patients," Leopere laments. "It's a very heavy handed way of trying to monitor excessive utilization when it really hurts patients who have difficulty getting to the physician."

Even though CMS wants to require visits before physicians can prescribe DME, it won't pay for visits solely for that reason, says the proposal published in the Aug. 5 Federal Register. Because doctors will have to come up with some other justification for visits other than prescribing DMEPOS, the requirement could "result in fraud of another sort," Dunaway fears.

Suppliers hope an outcry from physicians, who tend to have more clout with CMS, will keep the face-to-face exam from becoming a reality for most DMEPOS items.

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