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URGENT UPDATE TO MEDICARE PROVIDERS!
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New Face-to-Face
Requirements
Changing April 1st.
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Note: This section does not apply to Power Mobility Devices, as they are covered under a different statutory requirement.
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New Face-to-Face Requirement
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There are 155 items covered under the face-to-face requirement (Complete list – Appendix A) and major changes in the provisions of this new rule that are taking effect. It’s imperative that all DME providers have a complete and thorough understanding of these new changes as they can directly impact your bottom line.
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| The major provisions of this new rule include: |
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Physician must document that the physician, physician assistant, nurse practitioner, or clinical nurse specialist has had a face-to-face examination with a beneficiary in the six (6) months prior to the written order for certain items of DME
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A physician must verify that a F2F performed by a PA, NP, or CNS was performed within the six months prior to the creation of a prescription of the specified item. A single concurring signature and date is sufficient to satisfy this requirement.
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You must have documentation of the F2F requirement in your file prior to the delivery of these items. A date stamp or similar clearly indicating the date of receipt of the F2F record is required.
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CMS will be announcing enforcement of this requirement in Calendar Year 2014
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Physicians will be provided an additional payment, using code G0454, for signing/co-signing the face-to-face encounter of the PA/NP/CNS. The physician should not bill the G code when he/she conducts the face-to-face encounter. Note that the G code may only be paid to the physician one time per beneficiary per encounter, regardless of the number of covered items documented in the face-to-face encounter
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CMS made it clear that the delay of enforcement only applies to the face-to-face encounter requirements and does not impact provisions related to written orders prior to delivery - Effective January 1, 2014
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The written order for the DME must follow the guidance in the Program Integrity Manual, Chapter 5, Section 5.2.3 and include, at a minimum;
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The beneficiary's name
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The item of DME ordered
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The prescribing practitioner's National Provider Identifier (NPI)
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The signature of the ordering practitioner
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5
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The date of the order
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Review Appendix A for the complete list of items covered.
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Routinely Purchased Items
Reclassification to Capped Rental
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In the Nov. 22 final rule, CMS designates 78 codes as capped-rental (Complete List – Appendix B).
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Effective April 1, 2014, for wheelchair accessory codes classified under the capped rental DME payment category and furnished for use with a complex rehabilitative power wheelchair (that is, furnished to be used as part of the complex rehabilitative power wheelchair), the supplier must give the beneficiary the option of purchasing these accessories at the time they are furnished. These accessory items would be considered as part of the complex rehabilitative power wheelchair (codes K0835 – K0864) and associated lump sum purchase option set forth at 42 CFR 414.229(a)(5).
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If the beneficiary declines the purchase option, the supplier must furnish the items on a rental basis and payment will be made on a monthly rental basis in accordance with the capped rental payment rules.
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Review Appendix B for the complete list of Wheelchair
Related Codes Reclassified to Capped Rental Per CMS-1526-F
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Need to Learn More about the Reimbursement Process?
Click Here to Visit Drive's Reimbursement Resource Center
Find Drive's Suite of Products Here!
Assistance in Navigating the New Medicare Market - Introducing The Mobility Consultants, LLC
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Along with products and services to help suppliers thrive, Drive now offers information and a variety of services on Medicare reimbursement and compliance issues through The MOBILITY Consultants, LLC. These added value services can help answer the questions so many suppliers have about the mobility business, increase first time approvals and assist with all audits for Medicare claims.Along with products and services to help suppliers thrive, Drive now offers information and a variety of services on Medicare reimbursement and compliance issues through The MOBILITY Consultants, LLC. These added value services can help answer the questions so many suppliers have about the mobility business, increase first time approvals and assist with all audits for Medicare claims.
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The MOBILITY Consultants is in the business of providing a comprehensive resource for mobility reimbursement and regulatory compliance issues. For more information on The MOBILITY Consultants and a menu of services we offer, visit our website atwww.themobilityconsultants.net.
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Drive Medical
