CMS could move soon on face-to-face requirement

Friday, February 27, 2015

WASHINGTON – A new bill in the House of Representatives paves the way for CMS to start enforcing the face-to-face requirement.

Industry stakeholders say the agency has been waiting for Congress to expand the types of healthcare providers who can document the face-to-face encounter required for DME prescriptions.

Reps. Kevin Brady, R-Texas, chairman of the House Ways and Means Committee, and Jim McDermott, D-Wash., ranking member of the committee, introduced a bill Feb. 24 that would do just that.

“CMS has supported this behind the scenes,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That’s why they’ve been waiting for full enforcement.”

H.R. 1021, the Protecting the Integrity of Medicare Act, would, among other things, expand who can document the face-to-face encounter required for DME prescriptions to include physician assistants, nurse practitioners and clinical nurse specialists.

CMS implemented the face-to-face requirement on July 1, 2013, but hasn’t started enforcing it yet. The agency implemented the written order prior to delivery requirement at the same time and started enforcing it Jan. 1, 2014. 

Allowing PAs, NPs and clinical nurse specialists to document face-to-face encounters will help providers avoid delays in delivering equipment and services because they won’t have to wait for physicians to sign off on the prescriptions.

“It reduces the complexity of what’s already a monstrosity of paperwork,” said Andrea Stark, a reimbursement consultant with MiraVista.

Once CMS begins enforcing the face-to-face requirement, providers will need to secure medical records that prove the face-to-face encounter occurred before delivery, said Stark.

“Some providers are already attempting to collect these medical records in case of an audit or due to a prepay review, but the timeline for having fully executed and signed documents in their possession and date stamped before delivery is a new level of compliance,” she said. “It’s going to be the next hurdle to clear.”

Stakeholders say H.R. 1021 is on a fast track to being passed by the House—the bill is bipartisan, budget neutral and has already been marked up.

“In terms of Congress’ usual speed, this is lightning speed,” Bachenheimer said. “There is huge political momentum behind this, and I would expect movement on it relatively soon.”