DME MACs update face-to-face guidelines

Friday, May 30, 2014

WASHINGTON – The DME MACs on May 29 revised a bulletin on the face-to-face requirement to add information clarifying who may perform the in-person visit and the responsibilities of the ordering physician. The face-to-face exam must be performed by a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) within six months of the written order for certain DME. The responsibilities of the ordering physician include: documenting that the beneficiary was evaluated and/or treated for a condition that supports the need for the item; including sufficient medical information in the medical record to demonstrate that applicable coverage criteria are met; and providing a copy of the exam and prescription to the provider before the item can be delivered. The bulletin also notes that the treating practitioner that conducted the face-to-face exam doesn’t need to be the prescriber for the DME, but the prescriber must verify that the visit occurred within the six months prior to the date of his or her prescription and that he or she has documentation the exam was conducted.