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Medicare Compliance & Reimbursement

Home Health:

Why DMEPOS Rule Could Make Docs' Lives Harder

Published on Fri Sep 17, 2004

Physicians are required to see patients to prescribe supplies, but Medicare won't pay.

A new Medicare requirement places physicians squarely between a rock and a hard place.

As part of Operation Wheeler Dealer, the Centers of 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 (DMEPOS). But Medicare won't pay for a physician visit if the sole purpose is prescribing DMEPOS.

That means if a patient needs a new crutch, cane, hospital bed, wheelchair or oxygen concentrator at home, he or she will have to go to your office. The only way CMS will reimburse docs for that visit, however, is if there's also another reason for the encounter. Of course, physicians would need the appropriate documentation to support the separate encounter's medical necessity.

"We believe it is good clinical practice for the beneficiary to be seen by the physician for their medical condition and the physician to decide whether or not an item of DMEPOS is appropriate during the face-to-face examination of the beneficiary," CMS writes in the physician fee schedule proposed rule, published in the Aug. 5 Federal Register.

The only hope is that CMS may narrow or cancel this proposal in the final fee schedule. CMS specifically asks for comments on whether to apply this provision only to certain types of DMEPOS instead of all DMEPOS. Comments are due Sept. 26, and the final rule is expected Nov. 1.

Lesson Learned: A proposed rule requiring docs to see DMEPOS patients may spell big headaches for providers.

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